Kathleen Brunick, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

102791 Issued in MN

Practice address

6936 Garland LN N
Maple Grove, MN 55311-4642

Phone

(763) 416-9313

Fax

(763) 416-4530

NPI assigned

May 16, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Kidspeak LTD.

  • Speech-Language Pathologist
  • Minnetonka, MN
  • NPI 1336205004

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1477043354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6936 GARLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114642",
            "telephone_number": "763-416-9313",
            "fax_number": "763-416-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6936 GARLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114642",
            "telephone_number": "763-416-9313",
            "fax_number": "763-416-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNICK",
        "first_name": "KATHLEEN",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-16",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "102791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPIST",
            "identifier": "102791",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brook West Family Dentistry PA
• Michael Brooks
• William Clifford Brose, O.D.,
• Grace A. Brown, OD
• Patricia Fitzgerald Brown
• Alex Bruning
• Natalie Marie Bruno
• Judy Kay Brunsgaard, LICSW
• Michael Benjamin Buchman, LGSW
• Jill Noel Buechler, RPH

• Occupational Therapist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.