Active NPI
Jeremy Derheim, MA OTR/L
- Occupational Therapist
- Anoka, MN
National Provider Identifier
1922518885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 105473
- Practice address
- 2829 Verndale Ave
Anoka, MN 55303 - Phone
- (763) 231-2590
- NPI assigned
- Oct 5, 2017
- Sex
- Male
- 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 | 105473 | MN | Primary |
Addresses
Primary practice location
2829 Verndale Ave
Anoka, MN 55303
Mailing address
14130 Cottonwood Blvd
Becker, MN 55308
Phone (320) 267-3660
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)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507161600000",
"number": "1922518885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14130 COTTONWOOD BLVD",
"city": "BECKER",
"state": "MN",
"postal_code": "55308",
"telephone_number": "320-267-3660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2829 VERNDALE AVE",
"city": "ANOKA",
"state": "MN",
"postal_code": "55303",
"telephone_number": "763-231-2590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERHEIM",
"first_name": "JEREMY",
"credential": "MA OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-05",
"last_updated": "2017-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "105473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anoka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.