Provider Demographics
NPI:1295956852
Name:FETTIG, LINDSEY
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:FETTIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:ND
Mailing Address - Zip Code:58652
Mailing Address - Country:US
Mailing Address - Phone:701-843-8494
Mailing Address - Fax:701-843-8494
Practice Address - Street 1:100 ELM AVE
Practice Address - Street 2:
Practice Address - City:NEW SALEM
Practice Address - State:ND
Practice Address - Zip Code:58652
Practice Address - Country:US
Practice Address - Phone:701-843-8494
Practice Address - Fax:701-843-8494
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist