Individual
MARY ALICE BUETTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
921 43RD AVE N, FARGO, ND 58102-5320
(701) 793-3646
(701) 293-6892
Mailing address
2511 25TH ST S, FARGO, ND 58103-5009
(701) 866-5344
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
101102
MN
225XP0200X
Pediatric Occupational Therapist
Primary
771
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51413
—
ND
Enumeration date
01/11/2007
Last updated
07/09/2007
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