Individual
MISS JESSICA DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
7110 JORDAN DR, RAPID CITY, SD 57702-8738
(307) 277-3703
Mailing address
7110 JORDAN DR, RAPID CITY, SD 57702-8738
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1048
SD
225X00000X
Occupational Therapist
OT60853908
WA
Other
Enumeration date
04/23/2018
Last updated
12/12/2018
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