Provider Demographics
NPI:1669913224
Name:BEST, THERESA KAYE (COTA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:KAYE
Last Name:BEST
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 1:3352 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1051
Mailing Address - Country:US
Mailing Address - Phone:320-212-7731
Mailing Address - Fax:
Practice Address - Street 1:7505 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4501
Practice Address - Country:US
Practice Address - Phone:763-450-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200669314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN224Z00000XOtherHMOS
MN224Z00000XMedicaid
MN224Z00000XMedicaid