Provider Demographics
NPI:1790540235
Name:ENLIGHTEN THERAPY
Entity Type:Organization
Organization Name:ENLIGHTEN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L, PMH-C
Authorized Official - Phone:701-527-0928
Mailing Address - Street 1:5308 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9275
Mailing Address - Country:US
Mailing Address - Phone:701-527-0928
Mailing Address - Fax:
Practice Address - Street 1:5308 BEAVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-9275
Practice Address - Country:US
Practice Address - Phone:701-527-0928
Practice Address - Fax:701-751-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty