Basic Information
| Provider Information | |||||||||
| NPI: | 1881716629 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEELER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | KAYE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BERG | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | KAYE | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7250 FRANCE AVENUE SOUTH | ||||||||
| Address2: | SUITE 305 CAPERNAUM PEDIATRIC THERAPY, INC. | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522852840 | ||||||||
| FaxNumber: | 9522852830 | ||||||||
| Practice Location | |||||||||
| Address1: | 7250 FRANCE AVENUE SOUTH | ||||||||
| Address2: | SUITE 305 CAPERNAUM PEDIATRIC THERAPY, INC. | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522852840 | ||||||||
| FaxNumber: | 9522852830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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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 | 225XP0200X | 103177 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.