Healthcare Provider Details

I. General information

NPI: 1750205167
Provider Name (Legal Business Name): NELLIE SKYTLAND OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDSOR PL N
MANDAN ND
58554-8151
US

IV. Provider business mailing address

1401 11TH AVE SE
MANDAN ND
58554-4544
US

V. Phone/Fax

Practice location:
  • Phone: 701-638-8106
  • Fax:
Mailing address:
  • Phone: 701-516-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2321
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: