Individual provider Active NPI

Mikayla Wandersee, OTD, OTR/L

  • Occupational Therapist
  • Minneapolis, MN
National Provider Identifier
1215669155
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
1250 W Broadway Ave
Minneapolis, MN 55411-2533
Phone
(612) 668-0254
NPI assigned
Jun 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 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 Primary

Addresses

Primary practice location

1250 W Broadway Ave
Minneapolis, MN 55411-2533

Mailing address

1250 W Broadway Ave
Minneapolis, MN 55411-2533
Phone (612) 668-0254

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250508001561 MN Practitioner - Occupational Therapist in Private Practice 1254858608 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107551MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Speech & Therapy Services, LLC Occupational Therapist CurrentSince May 12, 2025 Accepting new patients
Special School District #1 Past Accepting new patients

Locations

1891 Station Pkwy NW
Andover, MN 55304
Phone (763) 307-4589

11100 86th Ave N
Maple Grove, MN 55369
Phone (612) 418-4324

Organizations & group practices 2

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": "1656460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1215669155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 W BROADWAY AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112533",
            "telephone_number": "612-668-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 W BROADWAY AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112533",
            "telephone_number": "612-668-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDERSEE",
        "first_name": "MIKAYLA",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-29",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; 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.