Individual provider Active NPI

Elizabeth Ann Jeska

  • Occupational Therapist
  • Apple Valley, MN
National Provider Identifier
1013409879
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
105675 Issued in MN
Practice address
14635 Pennock Ave Ste 300
Apple Valley, MN 55124-6588
Phone
(651) 994-9644
NPI assigned
Jun 6, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 105675 MN Primary

Addresses

Primary practice location

14635 Pennock Ave Ste 300
Apple Valley, MN 55124-6588

Mailing address

14635 Pennock Ave Ste 300
Apple Valley, MN 55124-6588
Phone (651) 994-9644

Other practice location 1

2795 Pilot Knob Rd Ste 100
Eagan, MN 55121-1930
Phone (651) 994-9644

Other identifiers 1

IdentifierTypeStateIssuer
1013409879MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105675MNMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Therapy Center, Inc Occupational Therapist CurrentSince Apr 30, 2019 Accepting new patients
Children'S Therapy Ctr, Inc PastSince Apr 30, 2019 Accepting new patients

Locations

14635 Pennock Ave
Ste 300
Apple Valley, MN 55124
Phone (651) 994-9644

2795 Pilot Knob Rd
Ste 100
Saint Paul, MN 55121
Phone (651) 994-9644

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1013409879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14635 PENNOCK AVE STE 300",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551246588",
            "telephone_number": "651-994-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14635 PENNOCK AVE STE 300",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551246588",
            "telephone_number": "651-994-9644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2795 Pilot Knob Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551211930",
            "country_code": "US",
            "telephone_number": "651-994-9644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JESKA",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-06",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "105675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013409879",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.