Provider Demographics
NPI:1891040291
Name:BEYOND BORDERS THERAPY SERVICES
Entity Type:Organization
Organization Name:BEYOND BORDERS THERAPY SERVICES
Other - Org Name:BEYOND BORDERS THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMCOX
Authorized Official - Suffix:
Authorized Official - Credentials:B S OTR/L
Authorized Official - Phone:763-370-6743
Mailing Address - Street 1:10101 QUINCE ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5146
Mailing Address - Country:US
Mailing Address - Phone:763-370-6743
Mailing Address - Fax:763-226-2452
Practice Address - Street 1:10101 QUINCE ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5146
Practice Address - Country:US
Practice Address - Phone:763-370-6743
Practice Address - Fax:763-226-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-21
Last Update Date:2012-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101919251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1447497037OtherNPI 1- PROVIDER NUMBER