NPIMap

Organization Active NPI

Great Kids Therapy, LTD.

  • Occupational Therapist
  • Fargo, ND
National Provider Identifier
1497805196
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
345 Issued in ND
Legal business name
GREAT KIDS THERAPY, LTD.
Practice address
3120 25TH St S Ste N
Fargo, ND 58103-6110
Phone
(701) 205-4194
Fax
(701) 504-9044
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Authorized official

Name
Kelsey Hoffman, OTR
Title
Owner
Phone
(701) 205-4194

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X 103207 ND
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 345 ND Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 103207 MN
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X 345 ND
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

3120 25TH St S Ste N
Fargo, ND 58103-6110

Mailing address

3120 25TH St S Ste N
Fargo, ND 58103-6110
Phone (701) 205-4194

Other identifiers 7

IdentifierTypeStateIssuer
7G316MEOtherMNBCBSMN IDENTIFICATION NO.
64-03941OtherNDUNITED HEALTH CARE
54375MedicaidND
322441043865OtherNDPREFERRED ONE
0007422496OtherNDAETNA
13667OtherNDBCBSND IDENTIFICATION NO.
64-03941OtherNDMEDICA

National Provider Directory

National Provider Directory
Tax ID family
Great Kids Therapy LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

102 W Beaton Dr
Ste 105
West Fargo, ND 58078
Phone (701) 205-4194

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1497805196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 25TH ST S STE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036110",
            "telephone_number": "701-205-4194",
            "fax_number": "701-504-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 25TH ST S STE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036110",
            "telephone_number": "701-205-4194",
            "fax_number": "701-504-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT KIDS THERAPY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-205-4194",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "ND",
            "license": "103207",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "345",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "103207",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ND",
            "license": "345",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN IDENTIFICATION NO.",
            "identifier": "7G316ME",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "64-03941",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54375",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "322441043865",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007422496",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSND IDENTIFICATION NO.",
            "identifier": "13667",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "64-03941",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.