Active NPI
Amy M Olderbak, OT
- Occupational Therapist
- Canton, SD
National Provider Identifier
1497955769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0651
- Practice address
- 440 N Hiawatha Dr
Canton, SD 57013 - Phone
- (605) 987-2621
- NPI assigned
- Jul 24, 2007
- 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 Therapist | 225X00000X | 0651 | SD | Primary |
Addresses
Primary practice location
440 N Hiawatha Dr
Canton, SD 57013
Mailing address
440 N Hiawatha Dr
Canton, SD 57013
Phone (605) 987-2621
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 |
|---|---|---|---|
| 0651 | SD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185235200000",
"number": "1497955769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 N HIAWATHA DR",
"city": "CANTON",
"state": "SD",
"postal_code": "57013",
"telephone_number": "605-987-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 N HIAWATHA DR",
"city": "CANTON",
"state": "SD",
"postal_code": "57013",
"telephone_number": "605-987-2621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLDERBAK",
"first_name": "AMY",
"middle_name": "M",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-24",
"last_updated": "2007-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SD",
"license": "0651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.