Healthcare Provider Details

I. General information

NPI: 1457130171
Provider Name (Legal Business Name): DEVOTED TO POTENTIAL, PROF. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27947 236TH ST
DRAPER SD
57531-3139
US

IV. Provider business mailing address

27947 236TH ST
DRAPER SD
57531-3139
US

V. Phone/Fax

Practice location:
  • Phone: 605-450-8978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MCKINSIE FUOSS
Title or Position: MEMBER
Credential: OTR/L
Phone: 605-450-8978