Healthcare Provider Details

I. General information

NPI: 1881319093
Provider Name (Legal Business Name): ADAPTIFY HOME SAFETY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 01/19/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19120 MYSTIQUE DR
CORCORAN MN
55340-9586
US

IV. Provider business mailing address

19120 MYSTIQUE DR
CORCORAN MN
55340-9586
US

V. Phone/Fax

Practice location:
  • Phone: 320-293-3205
  • Fax:
Mailing address:
  • Phone: 320-293-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LATASHA LARSON
Title or Position: OWNER
Credential: OTR/L
Phone: 320-293-3205