MEDICARE: MRS. MADELINE C GRAFF MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	104917	MN
2	225X00000X	Occupational Therapist	1747	ND

General Provider Information

NPI Number	:	1407527278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELINE C GRAFF MOTR/L

Provider Business Mailing Address
First Line	:	2615 5TH AVE N
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-2959
Country	:	US
Telephone Number	:	218-689-5878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 S COLUMBIA RD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4015
Country	:	US
Telephone Number	:	701-780-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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