Individual provider Active NPI

Madeline Charbonneau

  • Occupational Therapist
  • Eden Prairie, MN
National Provider Identifier
1114849759
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
108175 Issued in MN
Practice address
6545 Flying Cloud Dr Ste 201
Eden Prairie, MN 55344-3356
Phone
(952) 224-1919
Fax
(612) 999-1943
NPI assigned
Jul 27, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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 108175 MN Primary

Addresses

Primary practice location

6545 Flying Cloud Dr Ste 201
Eden Prairie, MN 55344-3356

Mailing address

6545 Flying Cloud Dr Ste 201
Eden Prairie, MN 55344-3356
Phone (952) 224-1919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6545 Flying Cloud Dr
Suite 201
Eden Prairie, MN 55344-3303

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Odom Sports Medicine, P.a. CurrentSince Jul 27, 2026 Accepting new patients

Locations

6545 Flying Cloud Dr
Ste 201
Eden Prairie, MN 55344
Phone (612) 364-1901

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": "1785110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1114849759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 FLYING CLOUD DR STE 201",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443356",
            "telephone_number": "952-224-1919",
            "fax_number": "612-999-1943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FLYING CLOUD DR STE 201",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443356",
            "telephone_number": "952-224-1919",
            "fax_number": "612-999-1943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARBONNEAU",
        "first_name": "MADELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-27",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "108175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.