Individual
JACEY PATRICIA WANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
300 N 7TH ST, BISMARCK, ND 58501-4439
(701) 323-6153
Mailing address
2200 46TH AVE SE APT 216, MANDAN, ND 58554-4852
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1626
ND
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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