Provider Demographics
NPI:1477635779
Name:ANDERSON, JESSICA (OTR)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2425
Mailing Address - Country:US
Mailing Address - Phone:701-662-2216
Mailing Address - Fax:701-401-0104
Practice Address - Street 1:213 5TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2425
Practice Address - Country:US
Practice Address - Phone:701-662-2216
Practice Address - Fax:701-401-0104
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24546OtherBCBS
ND54829Medicaid
ND54829Medicaid