Individual provider Active NPI

Melody Koerselman, OTR/L

  • Pediatric Occupational Therapist
  • Andover, MN
National Provider Identifier
1346828548
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Practice address
1891 Station Pkwy NW
Andover, MN 55304-3341
Phone
(763) 755-4275
NPI assigned
Mar 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X Primary

Addresses

Primary practice location

1891 Station Pkwy NW
Andover, MN 55304-3341

Mailing address

1891 Station Pkwy NW
Andover, MN 55304-3341
Phone (763) 755-4275

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210511000266 MN Practitioner - Occupational Therapist in Private Practice 8426467135 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Family Speech & Therapy Services, LLC CurrentSince Mar 25, 2021 Accepting new patients

Locations

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

15590 90th St NE
Otsego, MN 55330
Phone (763) 308-3869

Organizations & group practices 1

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": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1346828548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043341",
            "telephone_number": "763-755-4275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043341",
            "telephone_number": "763-755-4275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOERSELMAN",
        "first_name": "MELODY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.