Healthcare Provider Details

I. General information

NPI: 1629214333
Provider Name (Legal Business Name): SARAH JANE VATNSDAL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 32ND AVE S
FARGO ND
58103-6163
US

IV. Provider business mailing address

3114 CHELSEA AVE S
MOORHEAD MN
56560-5318
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-2340
  • Fax: 701-232-2330
Mailing address:
  • Phone: 701-361-0953
  • Fax: 701-232-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number978
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: