Provider Demographics
NPI:1275151086
Name:BACKMAN, SAJE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAJE
Middle Name:
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W BURLEIGH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9041
Mailing Address - Country:US
Mailing Address - Phone:701-527-9936
Mailing Address - Fax:
Practice Address - Street 1:1600 E INTERSTATE AVE # 5
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1226
Practice Address - Country:US
Practice Address - Phone:701-751-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist