Active NPI
Tracy Obermoller, OT
- Occupational Therapist
- Minneapolis, MN
National Provider Identifier
1962898916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 104868
- Practice address
- 420 Delaware St SE
Minneapolis, MN 55455-0341 - Phone
- (612) 273-6332
- NPI assigned
- Apr 7, 2015
- 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 | 104868 | MN | Primary |
Addresses
Primary practice location
420 Delaware St SE
Minneapolis, MN 55455-0341
Mailing address
3910 36TH Ave S
Minneapolis, MN 55406-3209
Phone (651) 403-3883
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428364800000",
"number": "1962898916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3910 36TH AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554063209",
"telephone_number": "651-403-3883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "612-273-6332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBERMOLLER",
"first_name": "TRACY",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-07",
"last_updated": "2015-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "104868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.