Active NPI
Jennifer Rafferty Brown, OTR
- Occupational Therapist
- Plymouth, MN
National Provider Identifier
1609355924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 103670
- Practice address
- 3390 Annapolis LN N Ste B
Plymouth, MN 55447-5379 - Phone
- (763) 898-6480
- NPI assigned
- Aug 8, 2018
- Last updated
- Aug 8, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | 103670 | MN | Primary |
Addresses
Primary practice location
3390 Annapolis LN N Ste B
Plymouth, MN 55447-5379
Mailing address
7714 Zanzibar LN N
Maple Grove, MN 55311-3706
Phone (763) 898-6480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210322001390 | MN | Practitioner - Occupational Therapist in Private Practice | 0547677494 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533686400000",
"number": "1609355924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7714 ZANZIBAR LN N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553113706",
"telephone_number": "763-898-6480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3390 ANNAPOLIS LN N STE B",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554475379",
"telephone_number": "763-898-6480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "JENNIFER",
"middle_name": "RAFFERTY",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-08",
"last_updated": "2018-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "103670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.