Provider Demographics
NPI:1043594252
Name:ECKSTEIN, KINZIE ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KINZIE
Middle Name:ELIZABETH
Last Name:ECKSTEIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KINZIE
Other - Middle Name:ELIZABETH
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5842 HOBE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-6477
Mailing Address - Country:US
Mailing Address - Phone:651-383-1197
Mailing Address - Fax:651-383-1198
Practice Address - Street 1:15 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3056
Practice Address - Country:US
Practice Address - Phone:651-964-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN140145225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health