Provider Demographics
NPI:1184052219
Name:RED RIVER PEDIATRIC THERAPY
Entity type:Organization
Organization Name:RED RIVER PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEISSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:701-361-9622
Mailing Address - Street 1:6681 56TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5655
Mailing Address - Country:US
Mailing Address - Phone:701-361-9622
Mailing Address - Fax:701-540-0191
Practice Address - Street 1:6681 56TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5655
Practice Address - Country:US
Practice Address - Phone:701-361-9622
Practice Address - Fax:701-540-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1008225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty