Provider Demographics
NPI:1760087019
Name:ULVOG, PAIGE ELIZABETH (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:ULVOG
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:ELIZABETH
Other - Last Name:RIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:7400 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-9247
Mailing Address - Country:US
Mailing Address - Phone:701-330-9084
Mailing Address - Fax:
Practice Address - Street 1:2951 S 34TH ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6061
Practice Address - Country:US
Practice Address - Phone:701-757-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist