Employment Change
If you are faxing, mailing or emailing a request to change information about your employment or business information, please include the following information:
Your name:
OT or OTA license number:
Current address:
New business name:
New business address:
New telephone number:
New fax number:
Your signature:
Date of employment change(mm/dd/yy):
OTs mail requests to:
Minnesota Department of Health
Health Occupations Program
Attn: Kim Ruberg
PO Box 64882
St. Paul, MN 55164-0882
Fax number: 651-201-3839
Email address: Kimberly.Ruberg@state.mn.us
OTAs mail requests to:
Minnesota Department of Health
Health Occupations Program
Attn: Patti Fuller
PO Box 64882
St. Paul, MN 55164-0882
Fax number: 651-201-3839
Email address: Patti.Fuller@state.mn.us
