Healthcare Provider Details

I. General information

NPI: 1114239084
Provider Name (Legal Business Name): KIRSTEN SLOMINSKI MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DIVISION AVE N SUITE B
CAVALIER ND
58220-4408
US

IV. Provider business mailing address

1806 2ND AVE N
GRAND FORKS ND
58203-3308
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8080
  • Fax:
Mailing address:
  • Phone: 218-791-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4624
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1209
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104172
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: