Provider Demographics
NPI:1851179683
Name:TREJO, PATRICIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:TREJO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 RUEMMELE RD APT 211
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6199
Mailing Address - Country:US
Mailing Address - Phone:805-354-9381
Mailing Address - Fax:
Practice Address - Street 1:1001 7TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2719
Practice Address - Country:US
Practice Address - Phone:701-662-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2013225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist