Provider Demographics
NPI:1982887121
Name:MOSSER, SOMMER LEA (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:SOMMER
Middle Name:LEA
Last Name:MOSSER
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:SOMMER
Other - Middle Name:LEA
Other - Last Name:HALVORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 29TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7186
Mailing Address - Country:US
Mailing Address - Phone:701-721-1200
Mailing Address - Fax:701-838-8444
Practice Address - Street 1:720 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6441
Practice Address - Country:US
Practice Address - Phone:701-721-1200
Practice Address - Fax:701-838-8444
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1014225X00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND225X00000XMedicaid
ND225X00000XMedicaid
ND225X00000XMedicare UPIN