Individual
WANDA G MAIXNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
305 8TH AVE NE, MINOT, ND 58703-2624
(701) 857-5905
(701) 857-5908
Mailing address
1630 5TH ST SE, MINOT, ND 58701-6324
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46
NDSBOTP
ND
01
—
AA393504
NBCOT
—
Enumeration date
12/11/2007
Last updated
12/11/2007
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