Active NPI
Elizabeth Jo Klocke
- Occupational Therapist
- Minnetonka, MN
National Provider Identifier
1811488323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 107229
- Practice address
- 5860 Baker Rd
Minnetonka, MN 55345-5903 - Phone
- (612) 778-8443
- NPI assigned
- May 21, 2018
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 107229 | MN | Primary |
Addresses
Primary practice location
5860 Baker Rd
Minnetonka, MN 55345-5903
Mailing address
74855 160TH Ave
Hayfield, MN 55940-8441
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107229 | MN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691366400000",
"number": "1811488323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74855 160TH AVE",
"city": "HAYFIELD",
"state": "MN",
"postal_code": "559408441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5860 BAKER RD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553455903",
"telephone_number": "612-778-8443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOCKE",
"first_name": "ELIZABETH",
"middle_name": "JO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-21",
"last_updated": "2023-08-07",
"certification_date": "2023-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "107229",
"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 Aug 7, 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.