Amanda Lane, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

102717 Issued in MN

Practice address

500 S Cherry St
Waconia, MN 55387-4515

Phone

(952) 856-4722

NPI assigned

Apr 29, 2019

Sex

Female

Sole proprietor

No

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.

• Odom Sports Medicine, P.a.

  • Sports Medicine (Family Medicine) Physician
  • Eden Prairie, MN
  • NPI 1275557886

  MN

  Medicare reassignment Care Compare group NPD

Specialty

Occupational Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Odom Sports Medicine PA 63 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 29, 2019.

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1780248419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10653 WAYZATA BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S CHERRY ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874515",
            "telephone_number": "952-856-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "AMANDA",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "102717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Kurtz, LADC
• Lucas Pierre Labine, MD
• Sarah Mae Laduke, MED CF-SLP
• Lakeview Clinic, LTD.
• Ann Landreville
• Samantha Jo Lanou
• Madeleine Victoria Larivella, CCC-SLP
• Mark R Larose, M.D.
• John W Larsen, M.D.
• Tamara Lynn Larsen, PT

• All providers in Waconia, MN
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.