Provider Demographics
NPI:1063226330
Name:MIDNIGHT AND MOONLIGHT LLC
Entity type:Organization
Organization Name:MIDNIGHT AND MOONLIGHT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERO-PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MAOT, OTR/L
Authorized Official - Phone:320-266-4304
Mailing Address - Street 1:3528 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3988
Mailing Address - Country:US
Mailing Address - Phone:320-266-4304
Mailing Address - Fax:
Practice Address - Street 1:3441 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2336
Practice Address - Country:US
Practice Address - Phone:126-913-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty