Active NPI
Brenna Ellis, OTD
- Occupational Therapist
- Minneapolis, MN
National Provider Identifier
1295567972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 107534
- Practice address
- 800 E 28TH St
Minneapolis, MN 55407-3723 - Phone
- (612) 863-4000
- NPI assigned
- Aug 20, 2024
- Sex
- Female
- 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 | 107534 | MN | Primary |
Addresses
Primary practice location
800 E 28TH St
Minneapolis, MN 55407-3723
Mailing address
2801 Lincoln St NE
Minneapolis, MN 55418-3057
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107534 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1295567972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 LINCOLN ST NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554183057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E 28TH ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073723",
"telephone_number": "612-863-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "BRENNA",
"credential": "OTD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-20",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "107534",
"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 Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.