WANDA J LICKTEIG (OTR/L, CHT) – Hand Occupational Therapist, NPI 1104932730
Hand Occupational Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
603 OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE in MN
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Provider Addresses for WANDA J LICKTEIG (OTR/L, CHT)
Koch Industries, Inc. | Lehigh Consumer Group, LLC, 4200, Dahlberg Drive, Glenwood Junction, Golden Valley, Hennepin County, Minnesota, 55422, United States
SUITE 300
GOLDEN VALLEY, MN 554224840
Phone: (952) 512-5600
Fax: (952) 512-5651
Type: Mailing
1701, Curve Crest Boulevard West, Stillwater, Washington County, Minnesota, 55082, United States
SUITE 104
STILLWATER, MN 550826044
Phone: (651) 439-8807
Fax: (651) 439-0232
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-10-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20041025001097 | I | Occupational Therapist In Private Practice | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97140 | Therapy procedure using manual technique, each 15 minutes | 60 | 14 | $0 |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 54 | 15 | $0 |
| 97535 | Training for self-care or home management, each 15 minutes | 46 | 21 | $0 |
| 97165 | Evaluation for occupational therapy, typically 30 minutes | 19 | 19 | $0 |
Insurance plans in this area (ZIP 55422)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| OCCUPATIONAL THERAPY | MN | 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 105 | 28 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Orthopedic Surgery | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | TX |
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