Individual provider Active NPI

Eliana Nicole Stienessen, MAOT, OTR/L

  • Occupational Therapist
  • Saint Cloud, MN
National Provider Identifier
1154957108
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
106404 Issued in MN
Practice address
2653 County Road 74
Saint Cloud, MN 56301-2205
Phone
(320) 229-4069
Fax
(320) 229-4071
NPI assigned
Mar 20, 2020
Last updated
Jan 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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 106404 MN Primary

Addresses

Primary practice location

2653 County Road 74
Saint Cloud, MN 56301-2205

Mailing address

1404 10TH St SE
Willmar, MN 56201-5421

Other identifiers 1

IdentifierTypeStateIssuer
5757OtherMNOCCUPATIONAL THERAPY PRACTICE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210504000478 MN Practitioner - Occupational Therapist in Private Practice 8325457328 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
106404MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Healtheast Outpatient Services, LLC Occupational Therapist CurrentSince Apr 9, 2022 Accepting new patients
Fairview Express Care CurrentSince Jan 3, 2022 Accepting new patients
Children's Therapy Works, Inc Occupational Therapist CurrentSince Apr 26, 2021 Accepting new patients
Fairview Express Care CurrentSince Jan 3, 2022 Accepting new patients

Locations

3305 Central Park Village Dr
Ste 130
Eagan, MN 55121
Phone (651) 406-8701

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

1825 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Organizations & group practices 5

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": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1154957108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 10TH ST SE",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2653 COUNTY ROAD 74",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563012205",
            "telephone_number": "320-229-4069",
            "fax_number": "320-229-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIENESSEN",
        "first_name": "ELIANA",
        "middle_name": "NICOLE",
        "credential": "MAOT, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-20",
        "last_updated": "2022-01-27",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPY PRACTICE LICENSE",
            "identifier": "5757",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; 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.