Healthcare Provider Details

I. General information

NPI: 1760882856
Provider Name (Legal Business Name): DEVAN REINHARDT MS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W MAIN ST STE B
BEULAH ND
58523
US

IV. Provider business mailing address

1307 CENTRAL AVE N
BEULAH ND
58523-6003
US

V. Phone/Fax

Practice location:
  • Phone: 701-880-8936
  • Fax:
Mailing address:
  • Phone: 701-873-5342
  • Fax: 701-873-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0816
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1685
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: