Provider Demographics
NPI:1881854792
Name:TANDBERG, JOY A (OTR, CHT, CHT, DRS)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:TANDBERG
Suffix:
Gender:F
Credentials:OTR, CHT, CHT, DRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CUMMINGS
Mailing Address - State:ND
Mailing Address - Zip Code:58223-2307
Mailing Address - Country:US
Mailing Address - Phone:701-330-4445
Mailing Address - Fax:855-952-5782
Practice Address - Street 1:225 2ND ST
Practice Address - Street 2:
Practice Address - City:CUMMINGS
Practice Address - State:ND
Practice Address - Zip Code:58223-2307
Practice Address - Country:US
Practice Address - Phone:701-330-4445
Practice Address - Fax:855-952-5782
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105703225X00000X
225X00000X, 225XH1200X
COOT.0001348225X00000X, 225XH1200X
ND1612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand