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General NPI Number Information
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NPI Number | 1184990608
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Entity Type | Organization
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Legal Business Name | STANDING ROCK EARLY CHILDHOOD TRACKING PROGRAM
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 001 STANDING ROCK AVENUE
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City | FT. YATES
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State | ND
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Zip | 58538
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Country | US
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Telephone | 701-854-3678
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 697
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City | FT. YATES
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State | ND
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Zip | 58538
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Country | US
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Telephone | 701-854-3678
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Fax | 701-854-7181
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. GEORGE D STARR
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Credential |
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Telephone | 701-854-3678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 551
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | ND
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