Provider Demographics
NPI:1225069693
Name:WASEMILLER, PEGGY J (OT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:WASEMILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:J
Other - Last Name:ORDELHEIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4153
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4153
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND301225X00000X
MN101442225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND770674OtherAMERICA'S PPO/ARAZ #
ND17856OtherNDBS #
ND6405552OtherMEDICA #
ND80520WAOtherMNBS #
ND40R30WAOtherMNBS #
ND42726OtherLHS #
ND6401681OtherMEDICA #
NDDA9011015523OtherPREFERRED ONE #
ND6405551OtherMEDICA #
ND17907OtherNDBS #
ND50334Medicaid
NDDA9051015523OtherPREFERRED ONE #
NDHP38649OtherHEALHTPARTNERS #
ND17907OtherNDBS #
NDDA9051015523OtherPREFERRED ONE #
ND17856Medicare ID - Type UnspecifiedND MEDICARE #
ND670001183Medicare UPIN
ND50334Medicaid