Healthcare Provider Details

I. General information

NPI: 1255565354
Provider Name (Legal Business Name): KAYLA KREMERS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E ASH AVE
GLEN ULLIN ND
58631-7138
US

IV. Provider business mailing address

227 16TH ST W STE 100
DICKINSON ND
58601-4675
US

V. Phone/Fax

Practice location:
  • Phone: 701-348-3107
  • Fax:
Mailing address:
  • Phone: 701-225-0767
  • Fax: 701-225-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1086
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: