JACQUELINE RAE WAGNER (NPI# 1861646010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861646010 |
| Entity Type | Individual |
| Full Name | JACQUELINE RAE WAGNER |
| Credential | OTR/L |
| Practice Address |
5842 Hobe Ln White Bear Lake MN 55110-4183 |
| Mailing Address |
5842 Hobe Ln White Bear Lake MN 55110 |
| Practice Telephone | 6513831197 |
| Practice Fax Number | 6513831198 |
| Mailing Telephone | 6513831197 |
| Mailing Fax Number | 6513831198 |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2019-12-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 225X00000X | Occupational Therapist | 103369 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1246 University Ave W Ste 100, Saint Paul, MN 551044183 | 6516038774 | 6516039009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366849473 | Jacqueline Nicole Wagner | Social Worker | 1613 M 139, Benton Harbor, MI 49022-5748 | 2014-12-04 |
| 1447598362 | Jacqueline Lee Wagner | Family Medicine | 1713 E Sherman Ave, Coeur D Alene, ID 83814-5326 | 2013-01-28 |
| 1104131648 | Jacqueline Wagner | Speech-Language Pathologist | 1640 N Wells St, Suite 103, Chicago, IL 60614-6087 | 2010-08-09 |
| Street Address |
5842 HOBE LN |
| City | WHITE BEAR LAKE |
| State | MN |
| Zip Code | 55110-4183 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609020858 | Wendy Noel Rufledt | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2008-11-13 |
| 1689171522 | Amanda Leigh Mccarthy | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2018-04-08 |
| 1609320605 | Evolvewell Occupational Therapy LLC | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2016-08-08 |
| 1528436011 | Ann Eckstrom | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110 | 2015-09-14 |
| 1679829899 | Jenica E Domanico | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2012-07-25 |
| 1952662843 | Jessica Ann Engman | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2012-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467071084 | St. Catherine University School Based Health Clinic | Nurse Practitioner | 5045 Division Ave, White Bear Lake, MN 55110 | 2020-04-14 |
| 1922450618 | Lisa Marie Thatcher | Podiatrist | 4653 White Bear Pkwy., St. Paul, MN 55110 | 2016-07-06 |
| 1558725598 | White Bear Dentists, PC | Dentist | 1970 Buerkle Road, White Bear Lake, MN 55110 | 2016-04-06 |
| 1124486246 | Julie Blaske | Counselor | 1310 Hwy 96 E, Suite 200, White Bear Lake, MN 55110 | 2016-02-03 |
| 1851761514 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 1920 Buerkle Rd, White Bear Lake, MN 55110 | 2015-10-06 |
| 1821496969 | Leah Eichmiller | Acupuncturist | 2183 3rd Street, C/o Indulge Salon, White Bear Lake, MN 55110 | 2014-12-05 |
| 1447672084 | Ashley Rath | Chiropractor | 1247 Gun Club Rd., White Bear Lake, MN 55110 | 2014-01-16 |
| 1790121291 | Advanced Medical Home Care, LLC | Home Health | 2555 County Road E East, Suite 101, White Bear Lake, MN 55110 | 2013-05-11 |
| 1134468465 | Emergency Physicians Professional Association | Clinic/Center | 1159 E. County Road E, Vadnais Heights, MN 55110 | 2013-02-06 |
| 1639444284 | Rebecca Lynn Blaede | Counselor | 4858 Banning Avenue, White Bear Lake, MN 55110 | 2012-03-15 |
| Find all providers in zip 55110 | ||||
| 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 |
|---|---|---|---|---|
| 1871012815 | Kathryn Perovich | Occupational Therapist | 2555 County Road E E Ste 102, White Bear Lake, MN 55110-4906 | 2017-09-11 |
| 1609020858 | Wendy Noel Rufledt | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2008-11-13 |
| 1548341423 | Therapy Partners, Inc. | Occupational Therapist | 4463 White Bear Pkwy, Suite 108, White Bear Lake, MN 55110-7645 | 2006-10-18 |
| 1609320605 | Evolvewell Occupational Therapy LLC | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2016-08-08 |
| 1528436011 | Ann Eckstrom | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110 | 2015-09-14 |
| 1952662843 | Jessica Ann Engman | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-6477 | 2012-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193326 | Shannon M Winn | Occupational Therapist | 529 Stine Dr, Carlton, MN 55718-9721 | 2020-10-26 |
| 1912504960 | Marissa Erin Rahlf | Occupational Therapist | 25834 710th St, Hayfield, MN 55940-8745 | 2020-10-02 |
| 1427662105 | Superior Therapy Solution LLC | Occupational Therapist | 1730 New St, Duluth, MN 55806-2114 | 2020-09-01 |
| 1083228753 | Rachel Anne Kramer | Occupational Therapist | 42808 County Road 11, Bird Island, MN 55310-3006 | 2020-09-01 |
| 1073123873 | Robert G Otos | Occupational Therapist | 8700 Virginia Cir N, Saint Louis Park, MN 55426-2455 | 2020-08-06 |
| 1164031787 | Melissa Cayetano Sanchez | Occupational Therapist | 6990 Wyndham Way, Woodbury, MN 55125-2761 | 2020-07-29 |
| 1275151896 | Integrative Therapies & Wellness | Occupational Therapist | 115 Willow St W Ste 4, Detroit Lakes, MN 56501-3922 | 2020-07-09 |
| 1760009153 | Traci Lynn Kruse | Occupational Therapist | 11437 Kenyon Ct Ne, Blaine, MN 55449-5483 | 2020-07-01 |
| 1376164244 | Madeline Rose Springer | Occupational Therapist | 19230 Larkspur Ave N, Marine On Saint Croix, MN 55047-9696 | 2020-05-02 |
| 1578182218 | Natalie Ryane Garfield | Occupational Therapist | 3025 Ottawa Ave S Apt 130, St Louis Park, MN 55416-2279 | 2020-04-13 |
| Find all providers with the same taxonomy | ||||
| City | WHITE BEAR LAKE |
| Zip Code | 55110 |
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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.