Mackenzie Sandra Danielson, MOT
Individual provider Active NPI Occupational Therapist · Grand Forks, ND
NPI 1245855147 · NPPES record last updated Jan 5, 2021
Key facts
- NPI
- 1245855147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 5785 (MN)
- Practice address
- 2600 Demers Ave Ste 101
Grand Forks, ND 58201-4100 - Phone
- (701) 739-5437
- Fax
- (701) 746-9198
- NPI assigned
- Jun 16, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200716002367 | ND | Practitioner - Occupational Therapist in Private Practice | 6002230190 | Reassigns benefits to 1 organization |
| I20210119001060 | MN | Practitioner - Occupational Therapist in Private Practice | 6002230190 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Partners, Inc. | Occupational Therapist | Current |
Accepting new patients |
Locations
419 Atlantic Ave
Thief River Falls, MN 56701
Phone (218) 416-1482
310 Red Lake Blvd
Thief River Falls, MN 56701
Phone (218) 416-1482
3060 Frontier Way S
Fargo, ND 58104
Phone (701) 356-4384
1811 S Washington St
Grand Forks, ND 58201
Phone (701) 757-3045
2600 Demers Ave
Ste 101
Grand Forks, ND 58201
Phone (701) 757-3045
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | |||
| Occupational Therapist | 225X00000X | 5785 | MN | Yes |
Addresses
Primary practice location
2600 Demers Ave Ste 101
Grand Forks, ND 58201-4100
Mailing address
2600 Demers Ave Ste 101
Grand Forks, ND 58201-4100
Phone (701) 739-5437
Other practice location 1
310 Red Lake Blvd
Thief River Falls, MN 56701-2133
Phone (218) 686-9575
Other providers in Grand Forks, ND
- Jeremiah Kim Danel
- Daniel & Max, LLC
- Allison Daniel
- Danielle Conrad, Licsw, PLLC
- Jennifer Mae Ann Daniels
- Naomi Danielson
- Kylee Danks
- Meridee Sue Danks
- Sherbie Darbouze
- Kal Datz
All providers in Grand Forks, ND · Occupational Therapist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.