Alyssa A Shirek, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

105100 Issued in MN

Practice address

102 W Beaton Dr Ste 105
West Fargo, ND 58078

Phone

(701) 261-4643

Fax

(701) 540-9044

NPI assigned

Jan 29, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alyssa A Jenkins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Great Kids Therapy, LTD.

  • Occupational Therapist
  • Fargo, ND
  • NPI 1497805196
  NPD (past)

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539648000000",
    "number": "1215435896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3507 EVERGREEN RD N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021218",
            "telephone_number": "701-261-4643",
            "fax_number": "701-365-8134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W BEATON DR STE 105",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "58078",
            "telephone_number": "701-261-4643",
            "fax_number": "701-540-9044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4420 37th Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581043400",
            "country_code": "US",
            "telephone_number": "701-365-4771",
            "fax_number": "701-365-8134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4420 37th Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581043400",
            "country_code": "US",
            "telephone_number": "701-365-4771",
            "fax_number": "701-365-8134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIREK",
        "first_name": "ALYSSA",
        "middle_name": "A",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-29",
        "last_updated": "2018-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "105100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "JENKINS",
            "middle_name": "A",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in West Fargo, ND
• Providers in West 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 Oct 16, 2018; 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.