Provider Demographics
NPI:1972113975
Name:SCHAEFER, KELSIE (MS, OTR/L, PMH-C)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MS, OTR/L, PMH-C
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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 1:2625 N 19TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0574
Practice Address - Country:US
Practice Address - Phone:701-222-3175
Practice Address - Fax:701-222-3186
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1480452Medicaid