Individual
MRS. LACEY D RUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6669
(701) 234-7451
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6669
(701) 234-7451
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
103538
MN
225XP0200X
Pediatric Occupational Therapist
Primary
964
ND
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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