Individual
MRS. SHAUNA R NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CLT
Contact information
Practice address
1711 GOLD DR S STE 120, FARGO, ND 58103-6416
(701) 451-9417
Mailing address
4450 31ST AVE S STE 104, FARGO, ND 58104-4557
(017) 451-9417
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
453
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3482838934
—
ND
Enumeration date
07/23/2018
Last updated
11/02/2020
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