Provider Demographics
NPI:1427242478
Name:ANDERSON, KEVIN KALIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:KALIN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 OAK CT
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-9531
Mailing Address - Country:US
Mailing Address - Phone:701-371-6709
Mailing Address - Fax:
Practice Address - Street 1:7409 OAK CT
Practice Address - Street 2:
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-9531
Practice Address - Country:US
Practice Address - Phone:701-371-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND285225XP0200X
MN102028225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics