Provider Demographics
NPI:1679840102
Name:SOISETH, GWENDALYN ANN (MOT OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GWENDALYN
Middle Name:ANN
Last Name:SOISETH
Suffix:
Gender:F
Credentials:MOT 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:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-2397
Mailing Address - Country:US
Mailing Address - Phone:701-572-6757
Mailing Address - Fax:
Practice Address - Street 1:222 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5658
Practice Address - Country:US
Practice Address - Phone:701-572-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist