Individual
LACEY JO BAKKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 417-3400
Mailing address
5225 23RD AVE S, FARGO, ND 58104-7927
(701) 417-3400
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1650
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1650
NDOTA
ND
Enumeration date
06/19/2019
Last updated
06/19/2019
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