Basic Information
| Provider Information | |||||||||
| NPI: | 1134212707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELSON KRIPPNER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | KELLY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 4TH STREET SOUTHWEST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202147082 | ||||||||
| FaxNumber: | 3202358059 | ||||||||
| Practice Location | |||||||||
| Address1: | 2653 COUNTY ROAD 74 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563012205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3204204080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 102487 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 64-05015 | 01 | MN | MEDICA | OTHER | 165554 | 01 | MN | UCARE | OTHER | 106177 | 01 | MN | HEALTH PARTNERS | OTHER | 507468100 | 05 | MN | MEDICAID | 412M2CH | 01 | MN | BLUE CROSS/BLUE SHIELD | OTHER |