Healthcare Provider Details

I. General information

NPI: 1841504636
Provider Name (Legal Business Name): JAMIE NICOLE MCDONALD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E HIGHWAY 61
ESKO MN
55733-9656
US

IV. Provider business mailing address

16 E HIGHWAY 61
ESKO MN
55733-9656
US

V. Phone/Fax

Practice location:
  • Phone: 218-655-5018
  • Fax:
Mailing address:
  • Phone: 218-655-5018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103922
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: