Provider Demographics
NPI:1518596709
Name:FREITAG, TODD DAVID
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:FREITAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 LOVETT AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6738
Mailing Address - Country:US
Mailing Address - Phone:701-222-0783
Mailing Address - Fax:701-222-3911
Practice Address - Street 1:2011 LOVETT AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6738
Practice Address - Country:US
Practice Address - Phone:701-222-0783
Practice Address - Fax:701-222-3911
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20933171W00000X, 171WH0202X
ND171WH0202X
MT4665224ZE0001X
ND1450224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification