Individual provider Active NPI

Barbara Jean Kloetzke, BS, COTA/L

  • Occupational Therapy Assistant
  • Stillwater, MN
National Provider Identifier
1740457076
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
200245 Issued in MN
Practice address
1119 Owens St N
Stillwater, MN 55082-4316
Phone
(651) 439-7180
Fax
(651) 439-4502
NPI assigned
May 15, 2008
Last updated
May 15, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 200245 MN Primary

Addresses

Primary practice location

1119 Owens St N
Stillwater, MN 55082-4316

Mailing address

1021 Glenhill Rd
Shoreview, MN 55126-8115
Phone (651) 483-4394

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
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
200245MNMDOccupational Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1740457076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 GLENHILL RD",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551268115",
            "telephone_number": "651-483-4394",
            "fax_number": "651-690-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 OWENS ST N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550824316",
            "telephone_number": "651-439-7180",
            "fax_number": "651-439-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOETZKE",
        "first_name": "BARBARA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "BS, COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-15",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "200245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.