Healthcare Provider Details

I. General information

NPI: 1588337992
Provider Name (Legal Business Name): OLIVIA ROSENTRETER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 36TH AVE SW STE 110
MINOT ND
58701-7597
US

IV. Provider business mailing address

2620 FORUM BLVD STE E
COLUMBIA MO
65203-5454
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-3175
  • Fax: 701-222-3186
Mailing address:
  • Phone: 573-514-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-173434
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2272
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: