Provider Demographics
NPI:1548288517
Name:AKERVIK, LAUREEN MARIE (COTA)
Entity type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:MARIE
Last Name:AKERVIK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13936 SUNSET LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7735
Mailing Address - Country:US
Mailing Address - Phone:952-426-1303
Mailing Address - Fax:
Practice Address - Street 1:1401 E 100TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-2615
Practice Address - Country:US
Practice Address - Phone:952-948-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200237224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant