Gabriel T Evenson, MOTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

995 Issued in ND

Practice address

3321 4TH Ave. S
Suite D
Fargo, ND 58103

Phone

(701) 200-8181

Fax

(701) 365-8585

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Water Therapy, LLC

  • Rehabilitation Clinic/Center
  • Fargo, ND
  • NPI 1245475797
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184716800000",
    "number": "1083742597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 47TH ST. S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58104",
            "telephone_number": "701-200-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3321 4TH AVE. S",
            "address_2": "SUITE D",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-200-8181",
            "fax_number": "701-365-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVENSON",
        "first_name": "GABRIEL",
        "middle_name": "T",
        "credential": "MOTRL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "27813",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Evans
• Melissa Ruth Evans, APRN, CNP
• Samantha Evans
• Candyce K Evanson, PA-C
• Alycia Evenocheck, LRD
• Josie Lynn Evenson
• Shelly Anne Evenson
• Chelsea Noel Evenstad, M.S., BCBA
• Eventide Fargo LLC (Eventide Fargo)
• Evernorth Care Providers - Arizona PC

• Occupational Therapist in Fargo, ND
• Providers in Fargo, ND by specialty
• Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.