Kris Antoni Rewald, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

201196 Issued in MN

Practice address

7505 Country Club Dr
Golden Valley, MN 55427-4501

Phone

(763) 545-0416

Fax

(763) 545-2016

NPI assigned

Dec 12, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229040000000",
    "number": "1942445390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 OAKWOOD DR",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551264824",
            "telephone_number": "651-484-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7505 COUNTRY CLUB DR",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274501",
            "telephone_number": "763-545-0416",
            "fax_number": "763-545-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REWALD",
        "first_name": "KRIS",
        "middle_name": "ANTONI",
        "name_prefix": "Mr.",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-12",
        "last_updated": "2008-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "201196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Occupational Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.