Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mellissa Mary Moen, OTR

Individual provider Occupational Therapist · NPI 1053652248

Mellissa Mary Moen, OTR is an Occupational Therapist in Private Practice in Saint Paul, Minnesota. Qualified in 2013, 13 years ago. Practices with Active Therapy Mn, a 22-clinician group.

Years since qualifying
13
In the registry since
2013
What do these letters mean?
OTR — Occupational Therapist, Registered
A nationally registered occupational therapist.

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Practice location Address checks out

1824 Old Hudson Rd
Saint Paul, MN 55119-4416
Phone: (763) 288-8208
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X

Record details

NPI number1053652248
Entity typeIndividual (Type 1)
GenderFemale
Credentials OTR
Sole proprietorNo
NPI enumeratedMarch 13, 2013
Last updated in NPPESApril 27, 2026
Certification dateApril 27, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Active Therapy Mn — 22 clinicians
Accepts Medicare assignment Not indicated

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