Active NPI
Stephanie Bruggman, OTR
- Occupational Therapist
- Edina, MN
National Provider Identifier
1114112463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 101101
- Practice address
- 4010 W 65TH St
Suite 105
Edina, MN 55435-1721 - Phone
- (952) 285-2840
- NPI assigned
- Sep 10, 2007
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 101101 | MN | Primary |
Addresses
Primary practice location
4010 W 65TH St
Suite 105
Edina, MN 55435-1721
Mailing address
13750 102ND St
Cologne, MN 55322-9039
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101101 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1114112463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13750 102ND ST",
"city": "COLOGNE",
"state": "MN",
"postal_code": "553229039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 W 65TH ST",
"address_2": "SUITE 105",
"city": "EDINA",
"state": "MN",
"postal_code": "554351721",
"telephone_number": "952-285-2840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUGGMAN",
"first_name": "STEPHANIE",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-10",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "101101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.