Organization
KELLY DREVECKY
Active
Other names
Prairie Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY LON DREVECKY OT R/L (OWNER/PRACTICIONER)
17017205355
Entity
Organization
Contact information
Practice address
700 HARMONY ST NW, MINOT, ND 58703-2892
(701) 720-5355
(701) 839-1311
Mailing address
700 HARMONY ST NW, MINOT, ND 58703-2892
(701) 720-5355
(701) 839-1311
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
612
ND
225XP0200X
Pediatric Occupational Therapist
Primary
612
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023153921
ALLI HAGER'S NPI
—
01
—
1457303695
NPI FOR KELLY DREVECKY
—
05
—
50609
—
ND
05
—
51145
—
ND
05
—
51500
—
ND
Enumeration date
08/07/2008
Last updated
08/07/2008
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