Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 395463 | ND |
NPI | 1386144129 |
---|---|
Provider Name | Brenna Faith Tescher |
First Address | Williston, ND 58801-1963 |
Second Address | Williston, ND 58801-4119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 19/02/2018 |