Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2251P0200X | Physical Therapist | Pediatrics | 103207 | NORTH DAKOTA | No |
| 2 | 225X00000X | Occupational Therapist | | 103207 | MINNESOTA | No |
| 3 | 225XP0200X | Occupational Therapist | Pediatrics | 345 | NORTH DAKOTA | No |
| 4 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 5 | 225X00000X | Occupational Therapist | | 345 | NORTH DAKOTA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 7G316ME | OTHER | MINNESOTA | BCBSMN IDENTIFICATION NO. |
| 2 | 64-03941 | OTHER | NORTH DAKOTA | UNITED HEALTH CARE |
| 3 | 54375 | MEDICAID | NORTH DAKOTA | |
| 4 | 322441043865 | OTHER | NORTH DAKOTA | PREFERRED ONE |
| 5 | 0007422496 | OTHER | NORTH DAKOTA | AETNA |
| 6 | 13667 | OTHER | NORTH DAKOTA | BCBSND IDENTIFICATION NO. |
| 7 | 64-03941 | OTHER | NORTH DAKOTA | MEDICA |