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NPI Code Detail

MEDICARE: MACI BAKKEN OT

MEDICARE: MACI BAKKEN OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistND

General Provider Information

NPI Number : 1255229951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACI BAKKEN OT
Provider Business Mailing Address
First Line : 2200 20TH ST SW
Second Line :
City : JAMESTOWN
State : ND
Zip : 58401-7500
Country : US
Telephone Number : 701-252-3850
Fax Number : 701-952-1450
Provider Business Practice Location Address
First Line : 4152 30TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58104-8524
Country : US
Telephone Number : 701-364-9070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2025
Last Update Date : 01/21/2026

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Directions to “ MACI BAKKEN OT” Practice Location

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