MEDICARE: FLEXIBIL OT 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
1	261QR0400X	Rehabilitation Clinic/Center	0597	SD

General Provider Information

NPI Number	:	1396805222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLEXIBIL OT INC

Provider Business Mailing Address
First Line	:	4824 ENCHANTED PINES DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9235
Country	:	US
Telephone Number	:	605-484-9759
Fax Number	:	605-721-5940

Provider Business Practice Location Address
First Line	:	4824 ENCHANTED PINES DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-9235
Country	:	US
Telephone Number	:	605-484-9759
Fax Number	:	605-721-5940

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOLLI MINER
Credential	:	OT
Telephone Number	:	605-484-9759

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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