Clara K Brimhall, COTA

Key facts

NPI

1194545285

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapy Assistant 224Z00000X

License

2027 (ND)

Practice address

4575 23Rd Ave S Ste 500
Fargo, ND 58104-8784

Phone

(701) 347-1782

NPI assigned

Oct 14, 2024

Sex

Female

Sole proprietor

No

Organizations & group practices 2

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

• Myna Therapy Services PLLC Multi-Specialty Clinic/Center · Fargo, ND · NPI 1427788629
  NPD
• Myna Early Intervention LLC Early Intervention Provider Agency · Fargo, ND · NPI 1639981343
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 14, 2024.

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1194545285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4575 23RD AVE S STE 500",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048784",
            "telephone_number": "701-347-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4575 23RD AVE S STE 500",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048784",
            "telephone_number": "701-347-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIMHALL",
        "first_name": "CLARA",
        "middle_name": "K",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "202795",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "ND",
            "license": "2027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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