Healthcare Provider Details

I. General information

NPI: 1578793014
Provider Name (Legal Business Name): KELSEY KAY CARTER MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY KAY LUND MA, OTR/L

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 18TH AVE SE #201
MINOT ND
58701-6732
US

IV. Provider business mailing address

2625 N 19TH ST
BISMARCK ND
58503-0574
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-4406
  • Fax: 701-838-2572
Mailing address:
  • Phone: 701-232-3175
  • Fax: 701-222-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number201570
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: