Organization
GREAT KIDS THERAPY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY HOFFMAN OTR (OWNER)
(701) 205-4194
Entity
Organization
Contact information
Practice address
3120 25TH ST S STE N, FARGO, ND 58103-6110
(701) 205-4194
(701) 504-9044
Mailing address
3120 25TH ST S STE N, FARGO, ND 58103-6110
(701) 205-4194
(701) 504-9044
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
103207
ND
225X00000X
Occupational Therapist
103207
MN
225X00000X
Occupational Therapist
Primary
345
ND
225XP0200X
Pediatric Occupational Therapist
345
ND
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007422496
AETNA
ND
01
—
13667
BCBSND IDENTIFICATION NO.
ND
01
—
322441043865
PREFERRED ONE
ND
05
—
54375
—
ND
01
—
64-03941
UNITED HEALTH CARE
ND
01
—
7G316ME
BCBSMN IDENTIFICATION NO.
MN
Enumeration date
01/12/2007
Last updated
02/07/2024
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