Elysia Florence Derks

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

106796 Issued in MN

Practice address

2925 Buckley Way
Inver Grove Heights, MN 55076-2018

Phone

(651) 455-0561

NPI assigned

Apr 11, 2022

Last updated

Jul 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elysia Florence Boles Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Achievement Center Inc.

  • Occupational Therapist
  • Woodbury, MN
  • NPI 1952411175
  Medicare reassignment NPD
• Therapy Ops, LLC

  • Speech-Language Pathologist
  • Inver Grove Heights, MN
  • NPI 1013323559

  Occupational Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1801538814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 WOODDALE DR STE A",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 BUCKLEY WAY",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550762018",
            "telephone_number": "651-455-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKS",
        "first_name": "ELYSIA",
        "middle_name": "FLORENCE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-11",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELYSIA",
            "last_name": "BOLES",
            "middle_name": "FLORENCE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Rae Dean, PCD(DONA)
• Lindsey Michelle-Patee Deeb, PNP
• Gregory S Defor, MD
• Petrea S Delich, RN
• Hayley Mae Demers, OTD, OTR/L
• Sandra Dickie
• Michael J Dillon, DDS
• Discovery Charter School
• Katelyn Dobias
• Amy Donovan, PHD

• Occupational Therapist in Inver Grove Heights, MN
• Providers in Inver Grove Heights, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.

Verify at the official NPI Registry.