Provider Demographics
NPI:1689207789
Name:PRAIRIE PEDIATRICS LLC
Entity Type:Organization
Organization Name:PRAIRIE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:MEIERHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:320-290-4003
Mailing Address - Street 1:10009 MAJESTIC AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7086
Mailing Address - Country:US
Mailing Address - Phone:320-290-4003
Mailing Address - Fax:
Practice Address - Street 1:274 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1303
Practice Address - Country:US
Practice Address - Phone:320-290-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty