Healthcare Provider Details

I. General information

NPI: 1376413559
Provider Name (Legal Business Name): ELISE GAPP OTD/OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SIENNA DR S STE 103
FARGO ND
58104-8910
US

IV. Provider business mailing address

3175 SIENNA DR S STE 103
FARGO ND
58104-8910
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-1906
  • Fax: 701-757-0120
Mailing address:
  • Phone: 701-532-1906
  • Fax: 701-757-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2289
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: