Provider Demographics
NPI:1336039890
Name:BICKNELL, EMILY MARY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARY
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 RED RIVER AVE N STE 5
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-1523
Mailing Address - Country:US
Mailing Address - Phone:320-200-4473
Mailing Address - Fax:320-584-2660
Practice Address - Street 1:402 RED RIVER AVE N
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1521
Practice Address - Country:US
Practice Address - Phone:320-200-4473
Practice Address - Fax:320-584-2660
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist