Basic Information
| Provider Information | |||||||||
| NPI: | 1689199523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUEHN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | COTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GOEDDERTZ | ||||||||
| OtherFirstName: | KAREN | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3315 ROOSEVELT RD STE 200A | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563019737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202294069 | ||||||||
| FaxNumber: | 3202294071 | ||||||||
| Practice Location | |||||||||
| Address1: | 3315 ROOSEVELT RD STE 200A | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202294069 | ||||||||
| FaxNumber: | 3202294071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2017 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 211640 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 2214 | AK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 201563 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.