Provider Demographics
NPI:1144311093
Name:HOFSTAD, ALLISON (OTR)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HOFSTAD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SCHONAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6991 86TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:STARKWEATHER
Mailing Address - State:ND
Mailing Address - Zip Code:58377-9317
Mailing Address - Country:US
Mailing Address - Phone:701-292-4217
Mailing Address - Fax:
Practice Address - Street 1:210 HIGHWAY 2 W STE 10
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2913
Practice Address - Country:US
Practice Address - Phone:701-662-1046
Practice Address - Fax:888-893-7316
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND101YA0400X
ND839225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23465OtherBCBS
ND27220OtherBCBS
MN616055700Medicaid
ND54578Medicaid