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NPI Code Detail

MEDICARE: TERESA JOY DAHLSTROM OTR

MEDICARE: TERESA JOY DAHLSTROM OTR
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 Therapist203ND

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 : 1952453144
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA JOY DAHLSTROM OTR
Provider Business Mailing Address
First Line : 5097 RIVER CREST RD
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-8073
Country : US
Telephone Number : 701-746-0667
Fax Number :
Provider Business Practice Location Address
First Line : 2400 47TH AVE S
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-3405
Country : US
Telephone Number : 701-746-2330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 07/08/2007

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