Individual provider Active NPI

Erin E Huberty, OTD, OTR/L

  • Pediatric Occupational Therapist
  • Fridley, MN
National Provider Identifier
1053018663
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
107050 Issued in MN
Practice address
7241 University Ave NE
Fridley, MN 55432-3134
Phone
(763) 450-9400
NPI assigned
Feb 14, 2023
Last updated
Feb 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 107050 MN Primary

Addresses

Primary practice location

7241 University Ave NE
Fridley, MN 55432-3134

Mailing address

1836 209TH CT NE
East Bethel, MN 55011-9746
Phone (763) 226-0864

Other identifiers 2

IdentifierTypeStateIssuer
107050OtherMNMN DEPARTMENT OF HEALTH
485938OtherNBCOT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240808001963 MN Practitioner - Occupational Therapist in Private Practice 1153868054 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107050MNMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Therapy Special Children's Clinic CurrentSince Jul 26, 2024 Accepting new patients

Locations

7241 University Ave NE
Minneapolis, MN 55432
Phone (763) 450-9400

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1053018663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 209TH CT NE",
            "city": "EAST BETHEL",
            "state": "MN",
            "postal_code": "550119746",
            "telephone_number": "763-226-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7241 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323134",
            "telephone_number": "763-450-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBERTY",
        "first_name": "ERIN",
        "middle_name": "E",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-14",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MN",
            "license": "107050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN DEPARTMENT OF HEALTH",
            "identifier": "107050",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBCOT",
            "identifier": "485938",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.