Healthcare Provider Details

I. General information

NPI: 1578426409
Provider Name (Legal Business Name): SARAH STADUM OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S STE 2
FARGO ND
58103-5800
US

IV. Provider business mailing address

20142 TAMARAC RD
PELICAN RAPIDS MN
56572-7021
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: