Individual provider Active NPI

Madelin Roberts, OTR/L

  • Occupational Therapist
  • Waconia, MN
National Provider Identifier
1093365769
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
106049 Issued in MN
Practice address
9346 Oak Ave
Waconia, MN 55387-9422
Phone
(952) 223-2506
NPI assigned
Sep 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 106049 MN Primary

Addresses

Primary practice location

9346 Oak Ave
Waconia, MN 55387-9422

Mailing address

9346 Oak Ave
Waconia, MN 55387-9422
Phone (529) 223-2506

Other practice location 1

5868 Baker Rd
Minnetonka, MN 55345-5903
Phone (952) 767-4200

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

State licenses

LicenseStateTypeSpecialty
106049MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sunnydays Therapy Inc Occupational Therapist CurrentSince Jan 11, 2020 Accepting new patients

Locations

9346 Oak Ave
Waconia, MN 55387
Phone (952) 442-5812

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.

NPI Registry JSON

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1093365769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9346 OAK AVE",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879422",
            "telephone_number": "529-223-2506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9346 OAK AVE",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879422",
            "telephone_number": "952-223-2506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5868 Baker Rd",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553455903",
            "country_code": "US",
            "telephone_number": "952-767-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MADELIN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-16",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.