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NPI Code Detail

MEDICARE: KERRY OLIVER OTRL

MEDICARE: KERRY OLIVER OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist102218MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1961S6OLOTHERMNBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3HP34809OTHERMNHEALTH PARTNERS
46401878OTHERMNMEDICA

General Provider Information

NPI Number : 1982747127
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY OLIVER OTRL
Provider Business Mailing Address
First Line : 3244 51ST ST S
Second Line :
City : FARGO
State : ND
Zip : 58104-7179
Country : US
Telephone Number : 701-356-0062
Fax Number : 701-356-5412
Provider Business Practice Location Address
First Line : 3244 51ST ST S
Second Line :
City : FARGO
State : ND
Zip : 58104-7179
Country : US
Telephone Number : 701-356-0062
Fax Number : 701-356-5412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 08/20/2025

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