Katie Hautman

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

106008 Issued in MN

Practice address

6545 Flying Cloud Dr Ste 201
Eden Prairie, MN 55344-3356

Phone

(612) 364-1901

NPI assigned

Jun 26, 2024

Sex

Female

Sole proprietor

No

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.

• Odom Sports Medicine, P.a.

  • Sports Medicine (Family Medicine) Physician
  • Eden Prairie, MN
  • NPI 1275557886

  MN

  Medicare reassignment Care Compare group NPD

Specialty

Occupational Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Odom Sports Medicine PA 63 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 26, 2024.

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1972348639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 FLYING CLOUD DR STE 201",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FLYING CLOUD DR STE 201",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443356",
            "telephone_number": "612-364-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUTMAN",
        "first_name": "KATIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "106008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rani Bedel Hassan
• Shukri Sadig Hassan
• Douglass S. Hassell, M.D.
• Michael Hastings
• Samuel J Hauck, MD
• Havvacare
• Mary Lynne Hawkes
• Jennifer Hays, PHARMD
• Tracie Heacox
• Heal Bridge Recuperative Care LLC

• All providers in Eden Prairie, MN
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.