Provider Demographics
NPI:1326383787
Name:OSWALD, JESSICA BETH (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BETH
Last Name:OSWALD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:BETH
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:2625 N 19TH ST
Mailing Address - Street 2:RED DOOR PEDIATRIC THERAPY
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0574
Mailing Address - Country:US
Mailing Address - Phone:701-222-3175
Mailing Address - Fax:701-222-3186
Practice Address - Street 1:2625 N 19TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0574
Practice Address - Country:US
Practice Address - Phone:701-222-3175
Practice Address - Fax:701-222-3186
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1228225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1454792Medicaid