Provider Demographics
NPI:1639551377
Name:RINAS, CARLIE DANIELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:DANIELLE
Last Name:RINAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:DANIELLE
Other - Last Name:BREKKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:500 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2039
Mailing Address - Country:US
Mailing Address - Phone:701-200-3038
Mailing Address - Fax:
Practice Address - Street 1:3175 SIENNA DR S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8910
Practice Address - Country:US
Practice Address - Phone:701-532-1906
Practice Address - Fax:701-532-1896
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND104599225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1422OtherNORTH DAKOTA OCCUPATIONAL THERAPY LICENSE
MN104599OtherLICENSED OCCUPATIONAL THERAPIST