Individual
MISS STACI RAE BLEECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
905 MAIN ST, LISBON, ND 58054-4334
(701) 683-6402
Mailing address
11 N MAIN ST, GWINNER, ND 58040-4001
(701) 678-2244
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1260
ND
Other
Enumeration date
02/09/2017
Last updated
11/12/2019
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