NPIMap

Organization Active NPI

Great Kids Therapy, LTD

  • Occupational Therapist
  • Fargo, ND
National Provider Identifier
1558743013
Registry record updated Feb 28, 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) 540-9044
NPI assigned
Jun 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Kelsey Hoffmann, OTR/L
Title
Owner
Phone
(701) 205-4194

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 345 ND Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 103207 MN

Addresses

Primary practice location

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

Mailing address

3507 Evergreen Rd N
Fargo, ND 58102-1218
Phone (701) 261-4643

Other identifiers 2

IdentifierTypeStateIssuer
54371MedicaidND
54375MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041007000490 ND Part B Supplier - Clinic/Group Practice 7315906062 Receives reassigned benefits from 13 practitioners
Practice locations: Fargo, ND

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

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

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1558743013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3507 EVERGREEN RD N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021218",
            "telephone_number": "701-261-4643",
            "fax_number": "701-293-0981"
        },
        {
            "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": "701-540-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT KIDS THERAPY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-22",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "HOFFMANN",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-205-4194",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "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
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54371",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54375",
            "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 28, 2024; 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.