Organization
PRAIRIE GRIT ADAPTIVE SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL RENE' BUTGEREIT MOT, OTR/L (EXECUTIVE DIRECTOR)
(208) 949-3315
Entity
Organization
Contact information
Practice address
3515 16TH ST SW, MINOT, ND 58701-7225
(208) 949-3315
Mailing address
PO BOX 969, MINOT, ND 58702-0969
(208) 949-3315
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/17/2020
Last updated
04/17/2020
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