Individual provider Active NPI

Corinne Alise Peick, MA, OTR/L

  • Occupational Therapist
  • Bloomington, MN
National Provider Identifier
1427587443
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
105176 Issued in MN
Practice address
900 W 94TH St
Bloomington, MN 55420-4206
Phone
(952) 885-0418
Fax
(952) 885-0173
NPI assigned
Jun 5, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 105176 MN Primary

Addresses

Primary practice location

900 W 94TH St
Bloomington, MN 55420-4206

Mailing address

900 W 94TH St
Bloomington, MN 55420-4206
Phone (952) 885-0418

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201002001620 MN Practitioner - Occupational Therapist in Private Practice 9638598154 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
105176MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Achievement Center Inc. Occupational Therapist CurrentSince Aug 3, 2020 Accepting new patients
The Therapy Place PastSince Jul 24, 2022 Accepting new patients

Locations

900 W 94th St
Bloomington, MN 55420
Phone (952) 885-0418

2101 Wooddale Dr
Ste A
Woodbury, MN 55125
Phone (651) 738-9888

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1427587443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 W 94TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554204206",
            "telephone_number": "952-885-0418",
            "fax_number": "952-885-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W 94TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554204206",
            "telephone_number": "952-885-0418",
            "fax_number": "952-885-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEICK",
        "first_name": "CORINNE",
        "middle_name": "ALISE",
        "credential": "MA, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "105176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.