Provider Demographics
NPI:1467957522
Name:OESTREICH, ALLI (OT)
Entity Type:Individual
Prefix:
First Name:ALLI
Middle Name:
Last Name:OESTREICH
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 1:1000 TACOMA AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7093
Mailing Address - Country:US
Mailing Address - Phone:701-751-3001
Mailing Address - Fax:
Practice Address - Street 1:1000 TACOMA AVE STE 500
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7093
Practice Address - Country:US
Practice Address - Phone:701-751-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist