Basic Information
| Provider Information | |||||||||
| NPI: | 1811077977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S THERAPY WORKS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 4TH ST SW STE 11 | ||||||||
| Address2: | |||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562013332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202147082 | ||||||||
| FaxNumber: | 3202358059 | ||||||||
| Practice Location | |||||||||
| Address1: | 2653 COUNTY ROAD 74 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563012205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202294069 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | DANIELSON KRIPPNER | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | KELLY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3204204080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OTRL | ||||||||
| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 379363 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225X00000X | 102487 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 412M2CH | 01 | MN | BC/BS BUSINESS | OTHER |