Dale Goodbrandson, OT

Key facts

NPI

1972328664

Entity type

Individual (NPI type 1)

Primary specialty

Occupational Therapist 225X00000X

Practice address

2200 Library Cir
Grand Forks, ND 58201-6326

Phone

(701) 757-2155

Fax

(701) 757-2156

NPI assigned

Nov 19, 2024

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• Little Miracles, Inc. Multi-Specialty Clinic/Center · Grand Forks, ND · NPI 1821110982
  Medicare reassignment NPD ND

Medicare participation

Medicare fee-for-service enrollment

Enrolled in ND

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2024.

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1972328664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2951 S 34TH ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016061",
            "telephone_number": "701-772-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 LIBRARY CIR",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016326",
            "telephone_number": "701-757-2155",
            "fax_number": "701-757-2156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1726 S Washington St Ste 23",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582016395",
            "country_code": "US",
            "telephone_number": "701-757-2155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2951 S 34th St",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582016061",
            "country_code": "US",
            "telephone_number": "701-772-3851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODBRANDSON",
        "first_name": "DALE",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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