Individual provider Active NPI

Jennifer Marie Frison, OTR/L

  • Pediatric Occupational Therapist
  • White Bear Lake, MN
National Provider Identifier
1578875142
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
103720 Issued in MN
Practice address
2555 County Road E E
White Bear Lake, MN 55110-4906
Phone
(651) 683-2953
NPI assigned
Jul 11, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 103720 MN Primary

Addresses

Primary practice location

2555 County Road E E
White Bear Lake, MN 55110-4906

Mailing address

6776 Lake Dr Ste 220
Lino Lakes, MN 55014-1192
Phone (651) 784-7007

Other practice location 1

6776 Lake Dr Ste 220
Lino Lakes, MN 55014-1192
Phone (651) 784-7007

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
103720MNMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Speech Therapy, LLC CurrentSince Aug 29, 2015 Accepting new patients

Locations

6776 Lake Dr
Ste 220
Lino Lakes, MN 55014
Phone (651) 784-7007

2555 County Road E E
White Bear Lk, MN 55110
Phone (651) 241-9200

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1278806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1578875142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6776 LAKE DR STE 220",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141192",
            "telephone_number": "651-784-7007",
            "fax_number": "651-784-7992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 COUNTY ROAD E E",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551104906",
            "telephone_number": "651-683-2953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6776 Lake Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Lino Lakes",
            "state": "MN",
            "postal_code": "550141192",
            "country_code": "US",
            "telephone_number": "651-784-7007",
            "fax_number": "651-784-7992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRISON",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-11",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MN",
            "license": "103720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.