NPIMap

Organization Active NPI

Prairie Independence PLLC

  • Occupational Therapist
  • Claremont, SD
National Provider Identifier
1306597232
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
PRAIRIE INDEPENDENCE PLLC
Practice address
12057 411TH Ave
Claremont, SD 57432-7302
Phone
(605) 290-1163
NPI assigned
Jan 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Jennifer Doreen Gustafson, OTR/L
Title
Occupational Therapist
Phone
(605) 290-1163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

12057 411TH Ave
Claremont, SD 57432-7302

Mailing address

12057 411TH Ave
Claremont, SD 57432-7302
Phone (605) 290-1163

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1306597232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12057 411TH AVE",
            "city": "CLAREMONT",
            "state": "SD",
            "postal_code": "574327302",
            "telephone_number": "605-290-1163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12057 411TH AVE",
            "city": "CLAREMONT",
            "state": "SD",
            "postal_code": "574327302",
            "telephone_number": "605-290-1163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE INDEPENDENCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "DOREEN",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "605-290-1163",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremont, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.