JESSIKA MAE VIOLA LACKIE (NPI# 1316457989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316457989 |
| Entity Type | Individual |
| Full Name | JESSIKA MAE VIOLA LACKIE |
| Credential | MOT |
| Practice Address |
1935 County Road B2 W Ste 100 Roseville MN 55113-2722 |
| Mailing Address |
141 4th St E Apt 525 Saint Paul MN 55101-2492 |
| Practice Telephone | 6516364155 |
| Mailing Telephone | 2069480551 |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2017-10-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225X00000X | Occupational Therapist | 105445 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1935 COUNTY ROAD B2 W STE 100 |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113-2722 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316313091 | Kelsey Jean Van Vickle | Speech-Language Pathologist | 1935 County Road B2 W Ste 100, Roseville, MN 55113-2722 | 2015-08-17 |
| 1972162154 | Emily Kollodge | Occupational Therapist | 1935 County Road B2 W Ste 100, Roseville, MN 55113-2722 | 2019-06-11 |
| 1407333461 | Ruth Carol Anderson-benge | Speech-Language Pathologist | 1935 County Road B2 W Ste 100, Roseville, MN 55113-2722 | 2018-07-23 |
| 1841728581 | Kathleen Wagner | Speech-Language Pathologist | 1935 County Road B2 W Ste 100, Roseville, MN 55113-2722 | 2017-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| 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 |
|---|---|---|---|---|
| 1154929941 | Mika Ley Cyrus Pacifico | Occupational Therapist | 1772 Casterbridge Dr, Roseville, CA 95747-4906 | 2020-10-13 |
| 1992310296 | Lauren Elizabeth Gollnick | Occupational Therapist | 5161 Foothills Blvd, Roseville, CA 95747-6546 | 2020-09-14 |
| 1679030027 | Maria Anna Leah Moncada David | Occupational Therapist | 5024 Stetson St, Roseville, CA 95747-9639 | 2019-02-21 |
| 1649759044 | Edinia Samson Holbrook | Occupational Therapist | 4248 Weathervane Way, Roseville, CA 95747-4213 | 2018-08-07 |
| 1679088264 | Michael Gerszewski | Occupational Therapist | 1835 County Road C W Ste 41, Roseville, MN 55113-1343 | 2017-12-05 |
| 1831563667 | Graham Chandler | Occupational Therapist | 1628 Quail Cir, Roseville, CA 95661-3612 | 2015-11-17 |
| 1386991149 | Elizabeth Mertz | Occupational Therapist | 8056 Bauser Ave, Roseville, CA 95747-5940 | 2012-08-11 |
| 1578818167 | Kristin Springfield | Occupational Therapist | 1680 E Roseville Pkwy Ste 112, Roseville, CA 95661-3988 | 2012-07-19 |
| 1740577220 | Laina Marie Haider | Occupational Therapist | 7950 Footthills Blvd, The Bridges At Woodcreek Oaks, Roseville, CA 95747 | 2011-07-05 |
| 1104123140 | Monica Soliman Barr | Occupational Therapist | 628 Hanisch Dr, Roseville, CA 95678-1260 | 2011-02-25 |
| Find all providers in ROSEVILLE | ||||
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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.