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General NPI Number Information
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NPI Number | 1255929097
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Entity Type | Organization
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Legal Business Name | PINE RIDGE THERAPY CENTER, LLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 2 3RD AVE SW
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City | TOWNER
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State | ND
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Zip | 58788-7751
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Country | US
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Telephone | 701-720-8857
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Fax |
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Provider Business Mailing Address
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Address Line | 798 56TH ST NE
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City | TOWNER
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State | ND
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Zip | 58788-9581
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Country | US
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Telephone | 701-720-8857
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | ALLISON MARIE ROGNLIEN
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Credential | MS, OTR/L, CLT
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Telephone | 701-720-8857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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