Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 979 | ND |
NPI | 1013319607 |
---|---|
Provider Name | Jeremiah Otteson |
First Address | Fargo, ND 58103-6104 |
Second Address | Fargo, ND 58103-6104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2014 |
Last Update Date | 25/09/2014 |