Active NPI
Richard Peter Vandendolder, OTR/L
- Occupational Therapist
- Golden Valley, MN
National Provider Identifier
1124375894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 101359
- Practice address
- 6701 Country Club Dr
Golden Valley, MN 55427-4602 - Phone
- (952) 993-5495
- Fax
- (952) 993-2250
- NPI assigned
- Aug 12, 2012
- Sex
- Male
- 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 | 101359 | MN | Primary |
Addresses
Primary practice location
6701 Country Club Dr
Golden Valley, MN 55427-4602
Mailing address
6701 Country Club Dr
Golden Valley, MN 55427-4602
Phone (952) 993-5495
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
| License | State | Type | Specialty |
|---|---|---|---|
| 101359 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344729600000",
"number": "1124375894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6701 COUNTRY CLUB DR",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554274602",
"telephone_number": "952-993-5495",
"fax_number": "952-993-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6701 COUNTRY CLUB DR",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554274602",
"telephone_number": "952-993-5495",
"fax_number": "952-993-2250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDENDOLDER",
"first_name": "RICHARD",
"middle_name": "PETER",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-12",
"last_updated": "2012-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "101359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Golden Valley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.