Individual
NICOLE RAE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4500 S WASHINGTON ST - ALTRU SPECIALTY CENTER, GRAND FORKS, ND 58201
(701) 780-7000
(701) 780-1942
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
(701) 780-1942
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
960
ND
Other
Enumeration date
06/01/2007
Last updated
03/06/2019
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