Individual provider Active NPI

Angelina Marie Caron, OTD, OTR/L

  • Occupational Therapist
  • Fargo, ND
National Provider Identifier
1962386706
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
107875 Issued in MN
Practice address
4575 23Rd Ave S Ste 400
Fargo, ND 58104-8783
Phone
(701) 347-1782
NPI assigned
Aug 4, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 107875 MN Primary
Occupational Therapist 225X00000X 2227 ND

Addresses

Primary practice location

4575 23Rd Ave S Ste 400
Fargo, ND 58104-8783

Mailing address

4810 28TH Ave S Unit 323
Fargo, ND 58104-9174
Phone (320) 304-9485

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250904003576 ND Practitioner - Occupational Therapist in Private Practice 9537661053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4575 23Rd Ave S
Suite 400
Fargo, ND 58104-8783

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2227NDMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Myna Early Intervention LLC CurrentSince Aug 1, 2025 Accepting new patients
Myna Therapy Services PLLC Occupational Therapist CurrentSince Aug 1, 2025 Accepting new patients

Locations

4575 23rd Ave S
Ste 400
Fargo, ND 58104
Phone (701) 347-1782

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.

NPI Registry JSON

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

{
    "created_epoch": "1754265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1962386706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 28TH AVE S UNIT 323",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581049174",
            "telephone_number": "320-304-9485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4575 23RD AVE S STE 400",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048783",
            "telephone_number": "701-347-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARON",
        "first_name": "ANGELINA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-04",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "107875",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "2227",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.