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Sally Ackerman

Individual provider Active NPI Occupational Therapy Assistant · Fargo, ND

NPI 1740734045 · NPPES record last updated Aug 4, 2016

Key facts

NPI
1740734045
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
738 (ND)
Practice address
4674 40TH Ave S Ste a
Fargo, ND 58104-4501
Phone
(701) 293-7294
Fax
(701) 282-9738
NPI assigned
Aug 4, 2016
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
738NDMDRegistered Dietitian
202028MNMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabauthority, LLC Past
since Apr 1, 2021		 Accepting new patients
At-Home Physical Therapy, PC Past
since Mar 1, 2005		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 738 ND Yes
Occupational Therapy Assistant 224Z00000X 202028 MN

Addresses

Primary practice location

4674 40TH Ave S Ste a
Fargo, ND 58104-4501

Mailing address

4674 40TH Ave S Ste a
Fargo, ND 58104-4501
Phone (701) 293-7294

Other providers in Fargo, ND

All providers in Fargo, ND · Occupational Therapy Assistant in North Dakota

Sources for this page

Verify at the official NPI Registry.