Individual
JENNIFER MAE QUALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
1905 14TH ST W, WILLISTON, ND 58801-6020
(701) 651-6437
(701) 516-8462
Mailing address
1905 14TH ST W, WILLISTON, ND 58801-6020
(701) 651-6437
(701) 516-8462
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1956
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1956
NORTH DAKOTA OCCUPATIONAL THERAPY LICENSE
ND
Enumeration date
07/07/2022
Last updated
09/02/2022
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