Mallory Jane W. Kantos, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

106194 Issued in MN

Practice address

2925 Buckley Way
Inver Grove Heights, MN 55076-2018

Phone

(651) 455-0561

NPI assigned

Mar 25, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mallory Jane Waytashek Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12435/brand/1/csg/1/fhir/r4

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.

• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Cloud, MN
  • NPI 1043212665
  Medicare reassignment NPD
• Sartell Pediatrics, P.a.

  • Pediatrics Physician
  • Sartell, MN
  • NPI 1215203898
  Medicare reassignment NPD
• St. Cloud Hospital

  • General Acute Care Hospital
  • Saint Cloud, MN
  • NPI 1043269798
  Medicare reassignment NPD
• Centracare Clinic

  • Occupational Medicine Clinic/Center
  • Saint Cloud, MN
  • NPI 1366192759
  NPD
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1407858020
  NPD
• St. Cloud Hospital

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Saint Cloud, MN
  • NPI 1467615294
  NPD
• St. Cloud Hospital

  • Psychiatric Hospital Unit
  • Saint Cloud, MN
  • NPI 1932419058
  NPD
• Therapy Ops, LLC

  • Speech-Language Pathologist
  • Inver Grove Heights, MN
  • NPI 1013323559

  Occupational Therapist

  NPD
• Kid Talk Inc

  • Speech-Language Pathologist
  • Victoria, MN
  • NPI 1245315027

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1952938268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4338 MCCOLL DR",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "553781535",
            "telephone_number": "320-250-9620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 BUCKLEY WAY",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550762018",
            "telephone_number": "651-455-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANTOS",
        "first_name": "MALLORY",
        "middle_name": "JANE W.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "MN",
            "license": "106194",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "WAYTASHEK",
            "middle_name": "JANE",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Stacey Junghans, M.A., LP
• JW Advantage Care, LLC
• K & W Services LLC
• Laura Kamugisha, MD
• Karen Lee Leyde
• Abdirabi Said Khalif
• Mariam Khella, DDS
• Kindled Strength Counseling, LLC
• Susan M Kinnee, APRN, CNP

• Occupational Therapist in Inver Grove Heights, MN
• Providers in Inver Grove Heights, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.