Individual provider Active NPI

Heather Dibra, MHS OTR/L

  • Ergonomics Occupational Therapist
  • Minot, ND
National Provider Identifier
1417907866
Registry record updated Mar 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ergonomics Occupational TherapistTaxonomy code 225XE1200X
License
OT10003 Issued in FL
Practice address
1715 S Broadway
Minot, ND 58701-6304
Phone
(701) 500-3582
Fax
(844) 272-1182
NPI assigned
May 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2015

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Ergonomics Occupational Therapist 225XE1200X OT10003 FL Primary
Neurorehabilitation Occupational Therapist 225XN1300X OT10003 FL
Environmental Modification Occupational Therapist 225XE0001X OT10003 FL
Pediatric Occupational Therapist 225XP0200X OT10003 FL
Physical Rehabilitation Occupational Therapist 225XP0019X OT10003 FL

Addresses

Primary practice location

1715 S Broadway
Minot, ND 58701-6304

Mailing address

1715 S Broadway
Minot, ND 58701-6304
Phone (701) 500-3582

Other identifiers 1

IdentifierTypeStateIssuer
887003900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250814003771 MT Practitioner - Occupational Therapist in Private Practice 2264411248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4120 King Ave W
Suite 1
Billings, MT 59106-2927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT10003FLMDErgonomics Occupational Therapist
1343NDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Concierge Health and Wellness PLLC CurrentSince Oct 1, 2023 Accepting new patients
Lea Anna Hughes LCSW CurrentSince Apr 22, 2024 Accepting new patients
New Heights Rehab LLC Neurorehabilitation CurrentSince May 29, 2013 Accepting new patients
Healis Rehabilitation Center Past Accepting new patients

Locations

311 NE 8th St
Ste 104
Homestead, FL 33030
Phone (305) 245-0356

4120 King Ave W
Ste 1
Billings, MT 59106
Phone (406) 707-6082

1715 S Broadway
Minot, ND 58701
Phone (701) 204-6274

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1417907866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 S BROADWAY",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016304",
            "telephone_number": "701-500-3582",
            "fax_number": "844-272-1182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 S BROADWAY",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016304",
            "telephone_number": "701-500-3582",
            "fax_number": "844-272-1182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBRA",
        "first_name": "HEATHER",
        "credential": "MHS OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XE1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Ergonomics",
            "state": "FL",
            "license": "OT10003",
            "primary": true
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "FL",
            "license": "OT10003",
            "primary": false
        },
        {
            "code": "225XE0001X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": "FL",
            "license": "OT10003",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "FL",
            "license": "OT10003",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "FL",
            "license": "OT10003",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887003900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.