Provider Demographics
NPI:1497805196
Name:GREAT KIDS THERAPY, LTD.
Entity Type:Organization
Organization Name:GREAT KIDS THERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:701-205-4194
Mailing Address - Street 1:3120 25TH ST S STE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6110
Mailing Address - Country:US
Mailing Address - Phone:701-205-4194
Mailing Address - Fax:701-504-9044
Practice Address - Street 1:3120 25TH ST S STE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6110
Practice Address - Country:US
Practice Address - Phone:701-205-4194
Practice Address - Fax:701-504-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1032072251P0200X
ND345225X00000X, 225XP0200X
MN103207225X00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7G316MEOtherBCBSMN IDENTIFICATION NO.
ND64-03941OtherUNITED HEALTH CARE
ND54375Medicaid
ND322441043865OtherPREFERRED ONE
ND0007422496OtherAETNA
ND13667OtherBCBSND IDENTIFICATION NO.
ND64-03941OtherMEDICA
ND54375Medicaid