Kelly Lon Drevecky, OT R/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

612 Issued in ND

Practice address

700 Harmony St NW
Minot, ND 58703-2892

Phone

(701) 720-5355

Fax

(701) 839-1311

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Practitioners 1

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

• Briana Jackson, M OTR/L

  • Occupational Therapist
  • Minot, ND
  • NPI 1003381054
  Medicare reassignment

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.

• Kelly Drevecky

  • Pediatric Occupational Therapist
  • Minot, ND
  • NPI 1629224860
  NPD Authorized official

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218067200000",
    "number": "1457303695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HARMONY ST NW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587032892",
            "telephone_number": "701-720-5355",
            "fax_number": "701-839-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HARMONY ST NW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587032892",
            "telephone_number": "701-720-5355",
            "fax_number": "701-839-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DREVECKY",
        "first_name": "KELLY",
        "middle_name": "LON",
        "name_prefix": "Mr.",
        "credential": "OT R/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "612",
            "primary": false
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "ND",
            "license": "612",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ND",
            "license": "612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50609",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dr. Robert Nyre
• Dr.Samir Farah MD,PC
• Todor Tode Dragicevic, M.D.
• Kaci Lynn Drapes, D.M.D
• Mercedes Drechsel
• Ashley C Drew, LCSW
• Caroline Drohan
• Clay Dubovoy
• Christina Duchaine
• Dana L Duchscherer, BS, LAC

• Pediatric Occupational Therapist in Minot, ND
• Providers in Minot, ND by specialty
• Pediatric Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.