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General NPI Number Information
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NPI Number | 1518905512
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Entity Type | Organization
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Legal Business Name | AXIS CLINIC PC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 1451 44TH AVE S STE 120D
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City | GRAND FORKS
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State | ND
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Zip | 58201-3434
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Country | US
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Telephone | 701-732-2947
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Fax | 701-732-4945
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Provider Business Mailing Address
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Address Line | 1451 44TH AVE S STE 120D
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City | GRAND FORKS
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State | ND
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Zip | 58201-3434
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Country | US
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Telephone | 701-732-2947
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Fax | 701-732-2945
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Authorized Official
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Title or Position | PRESIDENT
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Name | LANCE M NORMAN
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Credential | OTR/L, CHT
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Telephone | 701-792-2947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 25
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License Number State | ND
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