Madonna A. Mitzel, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

929 Issued in ND

Practice address

1702 E Main St Ste 103
Mandan, ND 58554-3818

Phone

(701) 415-0000

Fax

(833) 969-0195

NPI assigned

May 30, 2006

Last updated

Jun 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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

• Kids in Motion Inc

  • Physical Therapy Clinic/Center
  • Mandan, ND
  • NPI 1649736422
  NPD
• Prairiecare LLC

  dba PrairieCare

  • Psychiatric Hospital
  • Brooklyn Park, MN
  • NPI 1215182928
  NPD (past)

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1013964253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 94TH AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431992",
            "telephone_number": "763-762-6800",
            "fax_number": "763-315-6685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 E MAIN ST STE 103",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585543818",
            "telephone_number": "701-415-0000",
            "fax_number": "833-969-0195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5500 94th Ave N",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Park",
            "state": "MN",
            "postal_code": "554431992",
            "country_code": "US",
            "telephone_number": "763-762-6800",
            "fax_number": "763-315-6685",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Gateway Avenue",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "58501",
            "country_code": "US",
            "telephone_number": "701-751-3271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITZEL",
        "first_name": "MADONNA",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2023-06-15",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSND",
            "identifier": "23089",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51326",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Mandan, ND
• Providers in Mandan, ND by specialty
• Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.