Provider Demographics
NPI:1801402276
Name:CONNECT TELETHERAPY
Entity Type:Organization
Organization Name:CONNECT TELETHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-429-0300
Mailing Address - Street 1:6681 56TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5655
Mailing Address - Country:US
Mailing Address - Phone:701-232-1215
Mailing Address - Fax:701-540-0191
Practice Address - Street 1:6681 56TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5655
Practice Address - Country:US
Practice Address - Phone:701-232-1215
Practice Address - Fax:701-540-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty