MEDICARE: EMPOWERED PEDIATRIC THERAPY PLLC

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

General Provider Information

NPI Number	:	1457118457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED PEDIATRIC THERAPY PLLC

Provider Business Mailing Address
First Line	:	3628 HIDDEN CIR
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-7928
Country	:	US
Telephone Number	:	218-779-3633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 UNIVERSITY DR N UNIT B
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58102-1820
Country	:	US
Telephone Number	:	218-779-3633
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA GREGOIRE
Credential	:
Telephone Number	:	218-779-3633

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	01/26/2026

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Directions to “EMPOWERED PEDIATRIC THERAPY PLLC ” Practice Location

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