Courtney Vander Wal

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

107299 Issued in MN

Practice address

6625 Lyndale Ave S
Richfield, MN 55423-2373

Phone

(952) 285-2840

NPI assigned

Oct 3, 2023

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Capernaum Pediatric Therapy, Inc.

  • Specialist
  • Richfield, MN
  • NPI 1619978228
  NPD (past)

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1033999347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3246 BALSAM ST SW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553722754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6625 LYNDALE AVE S",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232373",
            "telephone_number": "952-285-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WAL",
        "first_name": "COURTNEY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-03",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "107299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Utopia Transportation Service LLC
• Anne Valaas-Turner, MD
• Alejandro Valdepena-Segura
• Victoria Carlos Valena, APRN, CNP
• Michael Lee Vallez, D.P.M.
• Kayleonna Nou Vang
• Taylor Nalee Vang
• Kaia Vangrinsven
• Ava Rose Yan Yan Venegas
• Erin Vierling, DPT

• Occupational Therapist in Richfield, MN
• Providers in Richfield, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.