Active NPI
Mai Moua
- Pediatric Occupational Therapist
- Minnetonka, MN
National Provider Identifier
1700237310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 105035
- Practice address
- 11606 Wayzata Blvd
Minnetonka, MN 55305-2009 - Phone
- (952) 554-0319
- NPI assigned
- Jun 24, 2016
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 105035 | MN | Primary |
Addresses
Primary practice location
11606 Wayzata Blvd
Minnetonka, MN 55305-2009
Mailing address
3742 Gershwin Ave N
Oakdale, MN 55128-3006
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466726400000",
"number": "1700237310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3742 GERSHWIN AVE N",
"city": "OAKDALE",
"state": "MN",
"postal_code": "551283006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11606 WAYZATA BLVD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553052009",
"telephone_number": "952-554-0319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUA",
"first_name": "MAI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-24",
"last_updated": "2016-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MN",
"license": "105035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.