Active NPI
Kaitlin Rose Halek, COTA
- Occupational Therapy Assistant
- Rogers, MN
National Provider Identifier
1689459133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 202711
- Practice address
- 9817 Garden LN
Rogers, MN 55374-9775 - Phone
- (601) 392-2097
- NPI assigned
- Aug 31, 2023
- 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 Therapy Assistant | 224Z00000X | 202711 | MN | Primary |
Addresses
Primary practice location
9817 Garden LN
Rogers, MN 55374-9775
Mailing address
4707 Highway 61 N # 150
White Bear Lake, MN 55110-3227
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 |
|---|---|---|---|
| 202711 | MN | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roots and Wings Therapeutic Services LLC | Current | Accepting new patients |
Locations
4707 Highway 61 N
White Bear Lake, MN 55110
Phone (608) 322-2722
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.
-
- Occupational Therapist
- Rogers, MN
- NPI 1902564420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693440000000",
"number": "1689459133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4707 HIGHWAY 61 N # 150",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551103227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9817 GARDEN LN",
"city": "ROGERS",
"state": "MN",
"postal_code": "553749775",
"telephone_number": "601-392-2097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALEK",
"first_name": "KAITLIN",
"middle_name": "ROSE",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-31",
"last_updated": "2023-08-31",
"certification_date": "2023-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MN",
"license": "202711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rogers, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.