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Individual

PAIGE NICOLE MCCULLOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2810 19TH AVE S, GRAND FORKS, ND 58201-5957
(701) 222-3175
(701) 222-3186
Mailing address
2625 N 19TH ST, BISMARCK, ND 58503-0574
(701) 222-3175
(701) 222-3186

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1812
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1480766
ND
Enumeration date
09/15/2020
Last updated
04/19/2022
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