Provider Demographics
NPI:1952029415
Name:KASPER, SIMON ROBERT
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:ROBERT
Last Name:KASPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 36TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5275
Mailing Address - Country:US
Mailing Address - Phone:701-532-1507
Mailing Address - Fax:701-532-1529
Practice Address - Street 1:4500 36TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5275
Practice Address - Country:US
Practice Address - Phone:701-532-1507
Practice Address - Fax:701-532-1529
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1969225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1969Medicaid