Provider Demographics
NPI:1881256402
Name:CLAUSON, ILSE MARIELLE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ILSE
Middle Name:MARIELLE
Last Name:CLAUSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515C S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6702
Mailing Address - Country:US
Mailing Address - Phone:701-330-4818
Mailing Address - Fax:701-335-7242
Practice Address - Street 1:2512 S WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6772
Practice Address - Country:US
Practice Address - Phone:701-330-4818
Practice Address - Fax:701-335-7242
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1707225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist