NPIMap

Organization Active NPI

Advance Occupational Therapy, LLC

Doing business as Advance Therapy

  • Occupational Therapist
  • Lino Lakes, MN
National Provider Identifier
1174730899
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
102776 Issued in MN
Legal business name
ADVANCE OCCUPATIONAL THERAPY, LLC
Doing business as
Advance Therapy
Practice address
6776 Lake Dr
Suite 220
Lino Lakes, MN 55014-1156
Phone
(651) 784-7007
Fax
(651) 784-7992
NPI assigned
May 16, 2007
Last updated
May 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

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

Authorized official

Name
Mrs. Jennifer Ann Corbin, MSNPI 1700846524
Title
Ceo/ Occupational Therapist
Phone
(651) 784-7007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X
Occupational Therapist 225X00000X 102776 MN Primary

Addresses

Primary practice location

6776 Lake Dr
Suite 220
Lino Lakes, MN 55014-1156

Mailing address

6776 Lake Dr
Suite 220
Lino Lakes, MN 55014-1156
Phone (651) 784-7007

Other names 1

  • Advance Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150603000076 MN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4880915891 Receives reassigned benefits from 13 practitioners
Practice locations: Lino Lakes, MN; White Bear Lake, MN

National Provider Directory

National Provider Directory

Locations

6776 Lake Dr
Ste 220
Lino Lakes, MN 55014
Phone (651) 784-7007

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1174730899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6776 LAKE DR",
            "address_2": "SUITE 220",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141156",
            "telephone_number": "651-784-7007",
            "fax_number": "651-784-7992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6776 LAKE DR",
            "address_2": "SUITE 220",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141156",
            "telephone_number": "651-784-7007",
            "fax_number": "651-784-7992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE OCCUPATIONAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "CORBIN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO/  OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "651-784-7007",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "102776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advance Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lino Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; 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.