Individual
JESSICA ANN AILIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(218) 732-8502
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104020
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
683227000
—
MN
Enumeration date
04/20/2011
Last updated
10/19/2018
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