Active NPI
Renee Haroldson, OTRL CHT
- Hand Occupational Therapist
- Maple Grove, MN
National Provider Identifier
1013975663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Occupational Therapist
- License
- 103981
- Practice address
- 14500 99TH Ave N
#1-210
Maple Grove, MN 55369-4730 - Phone
- (763) 898-1778
- Fax
- (763) 898-1771
- NPI assigned
- May 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | 103981 | MN | Primary |
Addresses
Primary practice location
14500 99TH Ave N
#1-210
Maple Grove, MN 55369-4730
Mailing address
14500 99TH Ave N
#1-210
Maple Grove, MN 55369-4730
Phone (763) 898-1778
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 192940 | Other | VA | BCBS OCCUPATIONAL THERAPY |
| 670001766 | Other | VA | RAILROAD MEDICARE |
| 8937141 | Medicaid | VA | |
| 7601113 | Other | AETNA |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidewater Physical Therapy, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Roanoke, VA
- NPI 1437664356
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364860800000",
"number": "1013975663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14500 99TH AVE N",
"address_2": "#1-210",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553694730",
"telephone_number": "763-898-1778",
"fax_number": "763-898-1771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14500 99TH AVE N",
"address_2": "#1-210",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553694730",
"telephone_number": "763-898-1778",
"fax_number": "763-898-1771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAROLDSON",
"first_name": "RENEE",
"name_prefix": "Ms.",
"credential": "OTRL CHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2013-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "MN",
"license": "103981",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OCCUPATIONAL THERAPY",
"identifier": "192940",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "670001766",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8937141",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7601113",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.