Healthcare Provider Details

I. General information

NPI: 1144572041
Provider Name (Legal Business Name): ALLISON K NORMAN MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON K RUTZ MOTR/L

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 WILLOW BEND DR
CASSELTON ND
58012
US

IV. Provider business mailing address

631 WILLOW BEND DR
CASSELTON ND
58012
US

V. Phone/Fax

Practice location:
  • Phone: 701-367-2602
  • Fax:
Mailing address:
  • Phone: 701-367-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1178
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103931
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: