Provider Demographics
NPI:1528159134
Name:BEUSSMAN, ERIN TASHA (OTRIL)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:TASHA
Last Name:BEUSSMAN
Suffix:
Gender:F
Credentials:OTRIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DUCKWOOD TRAILS
Mailing Address - Street 2:#310
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123
Mailing Address - Country:US
Mailing Address - Phone:651-454-6942
Mailing Address - Fax:
Practice Address - Street 1:900 W 94TH STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-885-0418
Practice Address - Fax:952-885-0173
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist