Healthcare Provider Details

I. General information

NPI: 1083871776
Provider Name (Legal Business Name): MIRANDA MARIE AUFFORTH MS OTR - L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 3RD STREET NE
PARSHALL ND
58770
US

IV. Provider business mailing address

6647 98TH ST NW
BOWBELLS ND
58721-9315
US

V. Phone/Fax

Practice location:
  • Phone: 701-862-3138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number946
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: