Provider Demographics
NPI:1013519933
Name:THOLE-JUDOVSKY, PRECIOUS JOY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PRECIOUS
Middle Name:JOY
Last Name:THOLE-JUDOVSKY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:PRECIOUS
Other - Middle Name:JOY
Other - Last Name:THOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:415 4TH ST. N.
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-446-1014
Mailing Address - Fax:701-446-1200
Practice Address - Street 1:415 4TH ST. N.
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-446-1014
Practice Address - Fax:701-446-1200
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant