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NPI Code Detail

MEDICARE: KINDRA DONVAN MS OTR/L

MEDICARE: KINDRA DONVAN MS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist1402ND

General Provider Information

NPI Number : 1114304581
Entity Type Code : Individual
Provider Name (Legal Business Name) : KINDRA DONVAN MS OTR/L
Provider Business Mailing Address
First Line : 222 UNIVERSITY AVE
Second Line :
City : WILLISTON
State : ND
Zip : 58801-5658
Country : US
Telephone Number : 701-572-6757
Fax Number :
Provider Business Practice Location Address
First Line : 222 UNIVERSITY AVE
Second Line :
City : WILLISTON
State : ND
Zip : 58801-5658
Country : US
Telephone Number : 701-572-6757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2015
Last Update Date : 09/26/2023

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