Carissa Poncelet

Individual provider Active NPI Occupational Therapy Assistant · Dell Rapids, SD

NPI 1245501295 · NPPES record last updated Jan 23, 2012

Key facts

NPI
1245501295
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
000815 (IA)
Practice address
706 Eagle Run
Dell Rapids, SD 57022-2142
Phone
(605) 428-5851
NPI assigned
Jan 23, 2012
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
000815IAMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 000815 IA Yes

Addresses

Primary practice location

706 Eagle Run
Dell Rapids, SD 57022-2142

Mailing address

4300 E Walker Way
Sioux Falls, SD 57103-1148
Phone (605) 480-0641

Other providers in Dell Rapids, SD

All providers in Dell Rapids, SD · Occupational Therapy Assistant in South Dakota

Sources for this page

Verify at the official NPI Registry.