Provider Demographics
NPI:1982747903
Name:SLATER, JONIE RAE (MS OTRL)
Entity Type:Individual
Prefix:
First Name:JONIE
Middle Name:RAE
Last Name:SLATER
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14643 43RD ST NW
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-8644
Mailing Address - Country:US
Mailing Address - Phone:701-774-1269
Mailing Address - Fax:
Practice Address - Street 1:1135 2ND AVE W STE 207
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4175
Practice Address - Country:US
Practice Address - Phone:701-581-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50888Medicaid