Provider Demographics
NPI:1801205448
Name:WETERING, JACY MARIE (MS, OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:MARIE
Last Name:WETERING
Suffix:
Gender:F
Credentials:MS, OTR/L, CLT
Other - Prefix:
Other - First Name:JACY
Other - Middle Name:MARIE
Other - Last Name:BJELLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:224 ELK ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7359
Mailing Address - Country:US
Mailing Address - Phone:605-755-7710
Mailing Address - Fax:
Practice Address - Street 1:224 ELK ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7359
Practice Address - Country:US
Practice Address - Phone:605-755-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist