Provider Demographics
NPI:1992851695
Name:BAUMGARTNER, JESSICA M (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BAUMGARTNER
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 1:4450 31ST AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4557
Mailing Address - Country:US
Mailing Address - Phone:701-451-9417
Mailing Address - Fax:701-298-0066
Practice Address - Street 1:4450 31ST AVE S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4557
Practice Address - Country:US
Practice Address - Phone:701-451-9417
Practice Address - Fax:701-298-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist