MELLISSA MARY MOEN OTR
NPI 1053652248
Occupational Therapist in Saint Paul, MN

Active since March 13, 2013
1824 OLD HUDSON RD, SAINT PAUL, MN 55119(763) 288-8208 Get Directions Write a Review

NPPES record last updated: April 27, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mellissa Mary Moen Otr NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MELLISSA MARY MOEN OTR (NPI 1053652248) is an individual occupational therapist in Saint Paul, Minnesota and active in the NPI registry since March 2013. She is a graduate of Other (2013).

NPPES Registry Identity

NPI1053652248
Entity TypeIndividualFemale
Primary Taxonomy225X00000X
Provider Legal NameMELLISSA MARY MOENCredential: OTR
Location Address1824 OLD HUDSON RDSaint Paul, MN 55119-4416
Mailing Address1219 Fallbrook LnWoodbury, MN 55125-9170
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateMarch 13, 2013
Last NPPES UpdateApril 27, 2026
NPPES CertifiedApril 27, 2026
✔ NPI 1053652248 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225X00000X
Definition
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.
1824 OLD HUDSON RD, Saint Paul, MN 55119

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mellissa Mary Moen Otr is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6103133061
PECOS Enrollment IDI20150910000649

Medicare Billing Reassignment

Medicare enrollment records show Mellissa Moen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Physical Therapist
10300 HENNEPIN TOWN RD
Eden Prairie, MN 55347
  • Reassigned Medicare billing, Minnesota enrollment
  • 27 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Social Worker (Clinical)
1824 OLD HUDSON RD
SAINT PAUL, MN 55119

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mellissa Moen's NPI number?

The NPI number for Mellissa Moen is 1053652248. It was assigned to this individual provider in the NPPES registry on March 13, 2013.

Where is Mellissa Moen located?

Mellissa Moen practices at 1824 Old Hudson Rd, Saint Paul, MN 55119. The listed phone number is (763) 288-8208.

What is Mellissa Moen's specialty?

The primary specialty registered for this NPI is Occupational Therapist with taxonomy code 225X00000X.

Is Mellissa Moen enrolled in Medicare?

Yes. Mellissa Moen is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mellissa Moen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mellissa Moen reassigns Medicare benefits to Active Therapy Mn (Eden Prairie, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mellissa Moen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mellissa Moen was last updated on April 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.