Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 225X00000X | Occupational Therapist | | 0063 | SOUTH DAKOTA | No |
| 2 | 225X00000X | Occupational Therapist | | 100335 | MINNESOTA | No |
| 3 | 225X00000X | Occupational Therapist | | 01344 | IOWA | No |
| 4 | 225XH1200X | Occupational Therapist | Hand | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 5830435 | MEDICAID | SOUTH DAKOTA | |
| 2 | 5830436 | MEDICAID | SOUTH DAKOTA | |
| 3 | 14G13GL | OTHER | MINNESOTA | BLUE CROSS BLUE SHIELD MN |
| 4 | 20141 | OTHER | SOUTH DAKOTA | SIOUX VALLEY HEALTH PLANS |
| 5 | 64-05326 | OTHER | SOUTH DAKOTA | MEDICA |
| 6 | 9G906GL | OTHER | SOUTH DAKOTA | BLUE CROSS BLUE SHIELD MN |
| 7 | 4994829 | OTHER | SOUTH DAKOTA | BLUE CROSS BLUE SHIELD SD |
| 8 | 64-04223 | OTHER | MINNESOTA | MEDICA |
| 9 | 24358 | OTHER | SOUTH DAKOTA | ARAZ |
| 10 | 4996802 | OTHER | SOUTH DAKOTA | BLUE CROSS BLUE SHIELD SD |
| 11 | 64-03863 | OTHER | MINNESOTA | MEDICA |
| 12 | 6434 | OTHER | MINNESOTA | AVERA HEALTH PLANS |
| 13 | 64-07558 | OTHER | SOUTH DAKOTA | MEDICA |
| 14 | 4996129 | OTHER | SOUTH DAKOTA | BLUE CROSS BLUE SHIELD SD |
| 15 | 64-01488 | OTHER | MINNESOTA | MEDICA |
| 16 | 4997070 | OTHER | SOUTH DAKOTA | BLUE CROSS BLUE SHEILD SD |
| 17 | 5830433 | MEDICAID | SOUTH DAKOTA | |
| 18 | 64-01485 | OTHER | SOUTH DAKOTA | MEDICA |
| 19 | 64-03581 | OTHER | MINNESOTA | MEDICA |
| 20 | 64-04204 | OTHER | SOUTH DAKOTA | MEDICA |
