Individual
SHEA BROGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
102 W BEATON DR STE 105, WEST FARGO, ND 58078
(701) 261-4643
(701) 540-9044
Mailing address
3507 EVERGREEN RD N, FARGO, ND 58102-1218
(701) 261-4643
(701) 540-9044
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
Primary
1351
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56430
—
ND
Enumeration date
07/02/2014
Last updated
10/16/2018
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