Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1166 | ND |
NPI | 1215330881 |
---|---|
Provider Name | Jessica Ann Tweten |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2014 |
Last Update Date | 26/09/2014 |