Healthcare Provider Details

I. General information

NPI: 1942116629
Provider Name (Legal Business Name): SARAH WOBBEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W INTERSTATE AVE
BISMARCK ND
58503-0964
US

IV. Provider business mailing address

1113 W CAPITOL AVE APT 116
BISMARCK ND
58501-1390
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2314
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: