Kelly Drevecky

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

612 Issued in ND

Legal business name

KELLY DREVECKY

Doing business as

Prairie Therapy

Practice address

700 Harmony St NW
Minot, ND 58703-2892

Phone

(701) 720-5355

Fax

(701) 839-1311

NPI assigned

Aug 7, 2008

Last updated

Aug 7, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kelly Lon Drevecky, OT R/LNPI 1457303695

Title

Owner/Practicioner

Phone

(701) 720-5355

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Prairie Therapy Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Lon Drevecky, OT R/L

  • Pediatric Occupational Therapist
  • Minot, ND
  • NPI 1457303695
  NPD Authorized official
• Briana Jackson, M OTR/L

  • Occupational Therapist
  • Minot, ND
  • NPI 1003381054
  NPD (past)
• Shay Johnson, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Minot, ND
  • NPI 1881316388
  NPD (past)
• Allyson Dawn Mayer, SPEECH LANGUAGE MS

  • Speech-Language Pathologist
  • Minot, ND
  • NPI 1639437346
  NPD (past)

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1629224860",
    "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": {
        "organization_name": "KELLY DREVECKY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-07",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "DREVECKY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "LON",
        "authorized_official_title_or_position": "OWNER/PRACTICIONER",
        "authorized_official_telephone_number": "17017205355",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OT R/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "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"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51145",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLI HAGER'S NPI",
            "identifier": "1023153921",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51500",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR KELLY DREVECKY",
            "identifier": "1457303695",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Madison Kellogg
• Kelsey Lynn Kellow, MS, CCC-SLP
• Kelly Chiropractic Center, PA
• Kelly Chiropractic, PA
• Kelly Chiropractic, PC
• Chad Garrett Kelly, D.C.
• Karen J Kelly, CRNA
• Krista C Kelly, D.C.
• Michael A Kelly Jr., D.C.
• Michael G Kelly, D.C.

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.