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NPI Code Detail

MEDICARE: BEYOND BOUNDARIES OCCUPATIONAL THERAPY, INC.

MEDICARE: BEYOND BOUNDARIES OCCUPATIONAL THERAPY, INC.
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
1261QH0700XHearing and Speech Clinic/Center
2225100000XPhysical Therapist
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
41041C0700XClinical Social Worker
5235Z00000XSpeech-Language Pathologist
6133V00000XRegistered Dietitian
7104100000XSocial Worker
8225X00000XOccupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2110574OTHERMNHEALTHPARTNERS

General Provider Information

NPI Number : 1245312388
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEYOND BOUNDARIES OCCUPATIONAL THERAPY, INC.
Provider Business Mailing Address
First Line : 3244 51ST ST S
Second Line :
City : FARGO
State : ND
Zip : 58104-7179
Country : US
Telephone Number : 701-356-0062
Fax Number : 701-356-5412
Provider Business Practice Location Address
First Line : 3244 51ST ST S
Second Line :
City : FARGO
State : ND
Zip : 58104-7179
Country : US
Telephone Number : 701-356-0062
Fax Number : 701-356-5412
Authorized Official
Title or Position : CEO
Name : LADONNA BANNACH
Credential : OTR/L
Telephone Number : 701-356-0062
Provider Enumeration Date : 10/19/2006
Last Update Date : 12/18/2025

Similar Medicare Providers

1558918805 — CONNIE MARIE ADAMS PT
Practice Location Address:
3244 51ST ST S
FARGO, ND
58104-7179
Practice Phone: 701-356-0062
Practice Fax: 701-356-5412
1700811338 — MRS. KATHARINE RHONDA RADERMACHER MS,CCC-SLP
Practice Location Address:
3244 51ST ST S
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Practice Phone: 701-261-4708
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1992727481 — MELISSA R ERDMANN FNP
Practice Location Address:
3274 51ST ST S
FARGO, ND
58104-7179
Practice Phone: 701-364-3660
Practice Fax: 701-364-3661
1437231578 — LADONNA BANNACH OTR/L
Practice Location Address:
3244 51ST ST S
FARGO, ND
58104-7179
Practice Phone: 701-356-0062
Practice Fax: 701-356-5412
1922155043 — MISS SHANNON MARIE BUCKMIER PT
Practice Location Address:
3244 51ST ST S
FARGO, ND
58104-7179
Practice Phone: 13-565-4127
Practice Fax: 701-356-5412
1982747127 — KERRY OLIVER OTRL
Practice Location Address:
3244 51ST ST S
FARGO, ND
58104-7179
Practice Phone: 701-356-0062
Practice Fax: 701-356-5412

Directions to “BEYOND BOUNDARIES OCCUPATIONAL THERAPY, INC. ” Practice Location

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