Provider Demographics
NPI:1396716585
Name:OBERG, KATHIE K (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:K
Last Name:OBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6274
Mailing Address - Country:US
Mailing Address - Phone:507-388-5437
Mailing Address - Fax:507-388-2108
Practice Address - Street 1:309 HOLLY LN
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6274
Practice Address - Country:US
Practice Address - Phone:507-388-5437
Practice Address - Fax:507-388-2108
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173K8OBOtherBCBS INDIV PROVIDER #
MN6404456OtherMEDICA INDIV PROVIDER #