Healthcare Provider Details

I. General information

NPI: 1386853802
Provider Name (Legal Business Name): ANNA LEE MEISSNER MS,OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6681 56TH AVE S
FARGO ND
58104-5655
US

IV. Provider business mailing address

6681 56TH AVE S
FARGO ND
58104-5655
US

V. Phone/Fax

Practice location:
  • Phone: 701-361-9622
  • Fax: 701-540-0191
Mailing address:
  • Phone: 701-361-9622
  • Fax: 701-540-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103419
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1008
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: