Michelle Marie Samuelson

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

102954 Issued in MN

Practice address

200 Main Ave S
Park Rapids, MN 56470-1518

Phone

(218) 732-0868

Fax

(218) 732-8502

NPI assigned

Nov 21, 2006

Sex

Female

Sole proprietor

Yes

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

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.

• Park Rapids Physical Therapy and Rehabilitation Center Inc

  • Physical Therapy Clinic/Center
  • Park Rapids, MN
  • NPI 1285706549
  NPD (past)
• Sanford Clinic North

  • Family Medicine Physician
  • Alexandria, MN
  • NPI 1548532468
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043385834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MAIN AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701518",
            "telephone_number": "218-732-0868",
            "fax_number": "218-732-8502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MAIN AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701518",
            "telephone_number": "218-732-0868",
            "fax_number": "218-732-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "MICHELLE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "102954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS IND ID #",
            "identifier": "13K2TH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA ID #",
            "identifier": "64-04244",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Ann Rollie, F.N.P, CNM
• Thomas Richard Rollie, M.D.
• Sara Marie Jansen Rowe, PHARMD
• Sheryl Jo Rudolf, APRN, CNP
• Amanda Dawn Runyan, DPT
• Sanford Clinic North
• Sanford Health of Northern Minnesota
• Ashley Sauer
• Nathan Schaefbauer, D.C.
• Troy Thomas Schmitz, OTR

• Occupational Therapist in Park Rapids, MN
• Providers in Park Rapids, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.