Kandyce Moen, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

100563 Issued in MN

Practice address

10069 Stacy TRL
Chisago City, MN 55013-9531

Phone

(763) 689-5385

NPI assigned

Sep 28, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Kandyce Kuby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Health Dimensions Rehabilitation Inc

  • Rehabilitation Clinic/Center
  • Cambridge, MN
  • NPI 1184733032
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1295827590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10069 STACY TRL",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10069 STACY TRL",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139531",
            "telephone_number": "763-689-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "KANDYCE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "100563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "05G60MO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP45836",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6402785",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KANDYCE",
            "last_name": "KUBY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Alene Martin, LMFT
• Richard John Mastenbrook, CNP
• Kelsey Lynn McCollum, APRN - CNP
• Minerva Center for Psychology PLLC
• Modern Dental Professionals Minnesota PC (Midwest Dental - Chisago City)
• Courtney Leigh Moore, DO
• Nicole Marie Noren, MA LADC LPCC
• Northwoods Chiropractic of Chisago City PA
• Parmly on the Lake Assisted Living LLC
• Parmly on the Lake LLC

• Occupational Therapist in Chisago City, MN
• Providers in Chisago City, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.