Healthcare Provider Details

I. General information

NPI: 1740061894
Provider Name (Legal Business Name): ALANNA R SICKLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3679 W PRINCETON AVE
BISMARCK ND
58504-7507
US

IV. Provider business mailing address

900 E BROADWAY
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-426-5176
  • Fax:
Mailing address:
  • Phone: 701-530-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1962
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: