Provider Demographics
NPI:1093744377
Name:RADERMACHER, TREENA (OT)
Entity Type:Individual
Prefix:
First Name:TREENA
Middle Name:
Last Name:RADERMACHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GWINNER
Mailing Address - State:ND
Mailing Address - Zip Code:58040-0586
Mailing Address - Country:US
Mailing Address - Phone:701-678-2244
Mailing Address - Fax:701-678-2210
Practice Address - Street 1:11 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:GWINNER
Practice Address - State:ND
Practice Address - Zip Code:58040-0586
Practice Address - Country:US
Practice Address - Phone:701-678-2244
Practice Address - Fax:701-678-2210
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51062Medicaid