Basic Information
Provider Information
NPI: 1104136092
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REITER
FirstName: CHELSEY
MiddleName: LEIGH
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HUNT
OtherFirstName: CHELSEY
OtherMiddleName: LEIGH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 5020
Address2:  
City: MINOT
State: ND
PostalCode: 587025020
CountryCode: US
TelephoneNumber: 7018575105
FaxNumber: 7018575646
Practice Location
Address1: 101 3RD AVE SW
Address2:  
City: MINOT
State: ND
PostalCode: 587013880
CountryCode: US
TelephoneNumber: 7018575286
FaxNumber: 7018575694
Other Information
ProviderEnumerationDate: 10/14/2010
LastUpdateDate: 09/10/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X1157NDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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