MEDICARE: ELISE GAPP OTD/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
1	225X00000X	Occupational Therapist	2289	ND

General Provider Information

NPI Number	:	1376413559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE GAPP OTD/OTR/L

Provider Business Mailing Address
First Line	:	3175 SIENNA DR S STE 103
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8910
Country	:	US
Telephone Number	:	701-532-1906
Fax Number	:	701-757-0120

Provider Business Practice Location Address
First Line	:	3175 SIENNA DR S STE 103
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8910
Country	:	US
Telephone Number	:	701-532-1906
Fax Number	:	701-757-0120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	06/03/2026

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