Active NPI
Donna Durand Ellig, MS OTRL
- Occupational Therapist
- Fargo, ND
National Provider Identifier
1154591790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 44
- Practice address
- 1725 North Broadway
Washington Elementary School
Fargo, ND 58102 - Phone
- (701) 446-5400
- NPI assigned
- Mar 11, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 44 | ND | Primary |
| Occupational Therapist | 225X00000X | 100926 | MN |
Addresses
Primary practice location
1725 North Broadway
Washington Elementary School
Fargo, ND 58102
Mailing address
415 North 4TH Street
Fargo, ND 58102-4514
Phone (701) 446-1034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100926 | MN | MD | Occupational Therapist |
| 44 | ND | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205193600000",
"number": "1154591790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 NORTH 4TH STREET",
"city": "FARGO",
"state": "ND",
"postal_code": "581024514",
"telephone_number": "701-446-1034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 NORTH BROADWAY",
"address_2": "WASHINGTON ELEMENTARY SCHOOL",
"city": "FARGO",
"state": "ND",
"postal_code": "58102",
"telephone_number": "701-446-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIG",
"first_name": "DONNA",
"middle_name": "DURAND",
"name_prefix": "Ms.",
"credential": "MS OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-11",
"last_updated": "2008-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ND",
"license": "44",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "100926",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.