Individual provider Active NPI

Daniel Klayton Olson

  • Pediatric Occupational Therapist
  • Shoreview, MN
National Provider Identifier
1821731282
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Practice address
490 Highway 96 W Ste 300
Shoreview, MN 55126-1961
Phone
(651) 451-3016
Fax
(651) 481-7040
NPI assigned
Apr 14, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X Primary

Addresses

Primary practice location

490 Highway 96 W Ste 300
Shoreview, MN 55126-1961

Mailing address

11976 84TH Ave N
Maple Grove, MN 55369-3060
Phone (612) 644-0700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230426002362 MN Practitioner - Occupational Therapist in Private Practice 4486019494 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kids Abilities, Inc CurrentSince Jan 17, 2023 Accepting new patients
Kids Abilities, Inc. CurrentSince Jan 17, 2023 Accepting new patients

Locations

4638 Victor Path
Ste 100
Hugo, MN 55038
Phone (651) 407-3777

490 Highway 96 W
Shoreview, MN 55126
Phone (651) 415-5490

490 Highway 96 W
Ste 300
Shoreview, MN 55126
Phone (651) 451-3016

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1821731282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11976 84TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553693060",
            "telephone_number": "612-644-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 HIGHWAY 96 W STE 300",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551261961",
            "telephone_number": "651-451-3016",
            "fax_number": "651-481-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "DANIEL",
        "middle_name": "KLAYTON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-14",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.