Blue Water Therapy, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

995 Issued in ND

Legal business name

BLUE WATER THERAPY, LLC

Practice address

3321 4TH Ave S Ste D
Fargo, ND 58103-2235

Phone

(701) 200-8181

NPI assigned

Dec 12, 2008

Organization subpart

No

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

Authorized official

Name

Gabriel Thomas Evenson, MOTR/L

Title

President

Phone

(701) 200-8181

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin M Hauschild, OT

  • Occupational Therapist
  • Fargo, ND
  • NPI 1801977798
  NPD (past)

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

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229040000000",
    "number": "1245475797",
    "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": "581044201",
            "telephone_number": "701-200-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3321 4TH AVE S STE D",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032235",
            "telephone_number": "701-200-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-12",
        "last_updated": "2008-12-12",
        "status": "A",
        "authorized_official_last_name": "EVENSON",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-200-8181",
        "authorized_official_credential": "MOTR/L"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "ND",
            "license": "995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Thomas Blotter, MD
• Blue Apple Wellness, LLP
• Blue Apple Wellness, LLP
• Noelle Estherlene Blue Arm, M.D.
• Blue Eye Inc
• Elizabeth R Blue
• Jennifer Blue
• Candice A Blumhardt, LPCC
• Rachel A Blumhardt
• Amber Blunt

• All providers in Fargo, ND
• Rehabilitation Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.

Verify at the official NPI Registry.