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General NPI Number Information
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NPI Number | 1669884151
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Entity Type | Organization
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Legal Business Name | AEGIS THERAPIES
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 2810 2ND AVE N
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City | MOORHEAD
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State | MN
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Zip | 56560-2508
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Country | US
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Telephone | 701-306-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 601 10TH AVE W
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City | WEST FARGO
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State | ND
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Zip | 58078-2531
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Country | US
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Telephone | 701-306-9580
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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 | SHAUNA RAE NELSON
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Credential | OTR/L
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Telephone | 701-306-9580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 104123
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 453
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License Number State | ND
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