Provider Demographics
NPI:1457130171
Name:DEVOTED TO POTENTIAL, PROF. LLC
Entity Type:Organization
Organization Name:DEVOTED TO POTENTIAL, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MCKINSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:605-450-8978
Mailing Address - Street 1:27947 236TH ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:SD
Mailing Address - Zip Code:57531-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27947 236TH ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:SD
Practice Address - Zip Code:57531-3139
Practice Address - Country:US
Practice Address - Phone:605-450-8978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty