Individual provider Active NPI

Amanda Bresnahan, OTR/L

  • Occupational Therapist
  • Woodbury, MN
National Provider Identifier
1891032827
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
106741 Issued in MN
Practice address
Family Achievement Center
2101 Wooddale Dr, Ste a
Woodbury, MN 55125
Phone
(651) 738-9888
Fax
(651) 738-9889
NPI assigned
Jan 10, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 106741 MN Primary
Occupational Therapy Assistant 224Z00000X 201822 MN

Addresses

Primary practice location

Family Achievement Center
2101 Wooddale Dr, Ste a
Woodbury, MN 55125

Mailing address

Family Achievement Center
2101 Wooddale Dr, Ste a
Woodbury, MN 55125
Phone (651) 738-9888

Other identifiers 1

IdentifierTypeStateIssuer
H100206610MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220310002002 MN Practitioner - Occupational Therapist in Private Practice 6901291897 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
201822MNMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Jun 1, 2023 Accepting new patients
Family Achievement Center Inc. Occupational Therapy Assistant CurrentSince Oct 9, 2022 Accepting new patients
Healtheast Outpatient Services, LLC Occupational Therapist CurrentSince Jun 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Jun 1, 2023 Accepting new patients
Fairview Health Services Past Accepting new patients
The Madison Center PastSince Apr 14, 2016 Accepting new patients

Locations

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

9220 Bass Lake Rd
Ste 260
New Hope, MN 55428
Phone (763) 533-0363

2101 Wooddale Dr
Ste A
Woodbury, MN 55125
Phone (651) 738-9888

1825 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Organizations & group practices 7

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": "1357776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1891032827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FAMILY ACHIEVEMENT CENTER",
            "address_2": "2101 WOODDALE DR, STE A",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "651-738-9888",
            "fax_number": "651-738-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FAMILY ACHIEVEMENT CENTER",
            "address_2": "2101 WOODDALE DR, STE A",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "651-738-9888",
            "fax_number": "651-738-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRESNAHAN",
        "first_name": "AMANDA",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-10",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106741",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "201822",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H100206610",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.