Active NPI
Jo Tierney, OTRL
- Occupational Therapist
- Eagan, MN
National Provider Identifier
1891839809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 102061
- Practice address
- 2795 Pilot Knob Rd
Suite 100
Eagan, MN 55121-1119 - Phone
- (651) 994-9644
- Fax
- (651) 994-8962
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 102061 | MN | Primary |
Addresses
Primary practice location
2795 Pilot Knob Rd
Suite 100
Eagan, MN 55121-1119
Mailing address
4058 Deerwood TRL
Eagan, MN 55122-1889
Phone (651) 994-9644
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HP41153 | Other | MN | HEALTH PARTNERS |
| 6403182 | Other | MN | MEDICA |
| 962S2TI | Other | MN | BCBS |
| 360959600 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102061 | MN | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Therapy Ctr, Inc | Past | Accepting new patients |
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.
-
- Speech-Language Pathologist
- Eagan, MN
- NPI 1295809366
-
- Speech-Language Pathologist
- Apple Valley, MN
- NPI 1053450742
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448928000000",
"number": "1891839809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4058 DEERWOOD TRL",
"city": "EAGAN",
"state": "MN",
"postal_code": "551221889",
"telephone_number": "651-994-9644",
"fax_number": "651-994-8962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2795 PILOT KNOB RD",
"address_2": "SUITE 100",
"city": "EAGAN",
"state": "MN",
"postal_code": "551211119",
"telephone_number": "651-994-9644",
"fax_number": "651-994-8962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIERNEY",
"first_name": "JO",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2015-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "102061",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP41153",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6403182",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "962S2TI",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "360959600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.