Provider Demographics
NPI:1457076002
Name:FULTON, MAISIE (OTD/R)
Entity type:Individual
Prefix:
First Name:MAISIE
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:OTD/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PHEASANT RUN AVE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6536
Mailing Address - Country:US
Mailing Address - Phone:701-483-3899
Mailing Address - Fax:701-483-3889
Practice Address - Street 1:664 12TH ST W STE C
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3511
Practice Address - Country:US
Practice Address - Phone:701-483-3899
Practice Address - Fax:701-483-3889
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist