KELLI MARIE MACK (NPI# 1215273065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215273065 |
| Entity Type | Individual |
| Full Name | KELLI MARIE MACK |
| Credential | OTR |
| Practice Address |
1415 Madison Ave Detroit Lakes MN 56501-4542 |
| Mailing Address |
28910 County Highway 54 Detroit Lakes MN 56501-7301 |
| Practice Telephone | 2188447119 |
| Mailing Telephone | 2182346747 |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2016-12-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225X00000X | Occupational Therapist | 102620 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275046237 | Kelli Alexandra Mack | Registered Nurse | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2017-11-13 |
| 1679515696 | Kelli C. Mack | Dentist | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2006-06-12 |
| Street Address |
1415 MADISON AVE |
| City | DETROIT LAKES |
| State | MN |
| Zip Code | 56501-4542 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215088521 | Ecumen | Skilled Nursing Facility | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2007-01-15 |
| 1124509500 | Patricia Marie Stalberger | Physical Therapist | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2018-08-24 |
| 1073094504 | Deerae Ann Nelson | Speech-Language Pathologist | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2018-08-23 |
| 1205370392 | Tess Kalberer | Occupational Therapist | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2016-12-08 |
| 1003214222 | Wendy Lynn Gordon | Dietitian, Registered | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2014-12-22 |
| 1780926444 | Ecumen | Home Health | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2013-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265649 | Candace Louise Haugtvedt | Pharmacist | 321 Us-10 West, Detroit Lakes, MN 56501 | 2020-11-05 |
| 1679068407 | Strive Chiropractic Detroit Lakes LLC | Chiropractor | 1852 Nodaway Drive, Detroit Lakes, MN 56501 | 2018-06-25 |
| 1194215830 | Jordan James Reese | Registered Nurse | 1295 Bay Ridge Dr, Detroit Lakes, MN 56501 | 2018-05-17 |
| 1992179386 | Compassion House | Substance Abuse Rehabilitation Facility | 811 8th St. Se, Detroit Lakes, MN 56501 | 2015-11-23 |
| 1720344286 | Lakes Crisis & Resource Center | Clinic/Center | 1339 Pelican Lane, Detroit Lakes, MN 56501 | 2012-04-09 |
| 1063657120 | Diane Jean Mccormack | Occupational Therapist | 15840 Long Lake Road, Detroit Lakes, MN 56501 | 2008-12-03 |
| 1588817928 | Darcy Caleb Olson | Counselor | 925 Lake Ave, Detroit Lakes, MN 56501 | 2008-10-29 |
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1427274729 | Jeffrey C Gregory | Psychologist | 910 Lincoln Ave, Detroit Lakes, MN 56501 | 2007-04-17 |
| 1144364894 | Midwest Vision Centers Inc | Eyewear Supplier (Equipment, not the service) | 830 Washington Avenue, Detroit Lakes, MN 56501 | 2007-02-16 |
| Find all providers in zip 56501 | ||||
| Taxonomy Code | 225X00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapist |
| An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275151896 | Integrative Therapies & Wellness | Occupational Therapist | 115 Willow St W Ste 4, Detroit Lakes, MN 56501-3922 | 2020-07-09 |
| 1215416896 | Cynthia Lou Gray | Occupational Therapist | Essentia Health St. Mary's Detroilakes, 1027 Washington Avenue, Detroit Lakes, MN 56501-3409 | 2018-08-14 |
| 1033455183 | Kelly J Soyring | Occupational Therapist | 18580 Totland Rd, Detroit Lakes, MN 56501-7603 | 2012-12-18 |
| 1386794931 | Therapy Services, Inc. | Occupational Therapist | 24238 E Island Lake Rd, Detroit Lakes, MN 56501-8105 | 2007-01-12 |
| 1689618662 | Erin Nichole Lindberg | Occupational Therapist | 115 Willow St W, Detroit Lakes, MN 56501-3922 | 2006-06-16 |
| 1669413027 | Jennifer Manning | Occupational Therapist | 803 Roosevelt Ave, Suite 301, Detroit Lakes, MN 56501 | 2006-06-09 |
| 1003384884 | Melissa M Hoffman | Occupational Therapist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2018-11-09 |
| 1265940290 | Mark H Dunham | Occupational Therapist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2018-01-11 |
| 1205370392 | Tess Kalberer | Occupational Therapist | 1415 Madison Ave, Detroit Lakes, MN 56501-4542 | 2016-12-08 |
| 1194110692 | Elizabeth Peterson | Occupational Therapist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2015-04-01 |
| Find all providers in DETROIT LAKES | ||||
| City | DETROIT LAKES |
| Zip Code | 56501 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.