Individual
MICHELLE I ENOCKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
599
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51530
—
ND
Enumeration date
05/26/2006
Last updated
07/13/2012
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