Provider Demographics
NPI:1760899082
Name:DYK, ANNA (OT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DYK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:FLATEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 W BEATON DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2653
Mailing Address - Country:US
Mailing Address - Phone:701-205-4194
Mailing Address - Fax:
Practice Address - Street 1:102 W BEATON DR STE 105
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078
Practice Address - Country:US
Practice Address - Phone:701-261-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist