Individual
CARISA BETHANY HRUBETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
11800 XEON BLVD NW, COON RAPIDS, MN 55448-2061
(763) 755-8400
(763) 755-8575
Mailing address
11800 XEON BLVD NW, COON RAPIDS, MN 55448-2099
(763) 755-8400
(763) 755-8578
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-105351
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962499566
—
MN
01
—
OT-105351
STATE LICENSE
MN
Enumeration date
05/14/2018
Last updated
01/16/2020
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