Joanna Nicole Anderson, OTR/L
Individual provider Active NPI Occupational Therapist · Mound, MN
NPI 1366201626 · NPPES record last updated Mar 18, 2024
Key facts
- NPI
- 1366201626
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 106436 (MN)
- Practice address
- 1861 Commerce Blvd
Mound, MN 55364-1293 - Phone
- (952) 240-3285
- NPI assigned
- Mar 18, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240523003102 | MN | Practitioner - Occupational Therapist in Private Practice | 8123460060 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Group Practice LLC | Occupational Therapist | Current | Accepting new patients |
| Aegis Group Practice LLC | Occupational Therapist | Current |
Accepting new patients |
| Aegis Group Practice LLC | Occupational Therapist | Current |
Accepting new patients |
Locations
1861 Commerce Blvd
Mound, MN 55364
Phone (612) 430-8150
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 106436 | MN | Yes |
Addresses
Primary practice location
1861 Commerce Blvd
Mound, MN 55364-1293
Mailing address
4786 Carrick Rd
Mound, MN 55364-1873
Phone (612) 601-6197
Other providers in Mound, MN
- Advanced Dental Care Services
- Aegis Group Practice LLC
- Grant U Anderton
- James Michael Baldus
- Jo M Berger
- Mi Ja Kang Bergerson
- Kimberly Anne Buffington-Latour
All providers in Mound, MN · Occupational Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.