Organization
PRAIRIE INDEPENDENCE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DOREEN GUSTAFSON OTR/L (OCCUPATIONAL THERAPIST)
(605) 290-1163
Entity
Organization
Contact information
Practice address
12057 411TH AVE, CLAREMONT, SD 57432-7302
(605) 290-1163
Mailing address
12057 411TH AVE, CLAREMONT, SD 57432-7302
(605) 290-1163
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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