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NPI Code Detail

MEDICARE: MRS. LEAH S. HERMANSON-FAUL

MEDICARE: MRS. LEAH S. HERMANSON-FAUL
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
1225X00000XOccupational Therapist766ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851509756
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LEAH S. HERMANSON-FAUL
Provider Business Mailing Address
First Line : 309 2ND ST E
Second Line :
City : BOTTINEAU
State : ND
Zip : 58318-1104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 309 2ND ST E
Second Line :
City : BOTTINEAU
State : ND
Zip : 58318-1104
Country : US
Telephone Number : 701-228-3743
Fax Number : 701-228-3365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/09/2007

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