Active NPI
Cassidy Ericksen
- Occupational Therapy Assistant
- Maplewood, MN
National Provider Identifier
1376076562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 202015
- Practice address
- 1670 Legacy Pkwy E
Maplewood, MN 55109-5469 - Phone
- (952) 697-0627
- Fax
- (479) 201-2084
- NPI assigned
- Apr 5, 2017
- 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 Therapy Assistant | 224Z00000X | 202015 | MN | Primary |
Addresses
Primary practice location
1670 Legacy Pkwy E
Maplewood, MN 55109-5469
Mailing address
1670 Legacy Pkwy E
Maplewood, MN 55109-5469
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 |
|---|---|---|---|
| 202015 | MN | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491350400000",
"number": "1376076562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1670 LEGACY PKWY E",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551095469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 LEGACY PKWY E",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551095469",
"telephone_number": "952-697-0627",
"fax_number": "479-201-2084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSEN",
"first_name": "CASSIDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-05",
"last_updated": "2017-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MN",
"license": "202015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.