| Doctor Name: | JEREMIAH OTTESON |
| NPI Number: | 1013319607 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MOTR/L |
| License Number: | 979 |
| Business Practice Address: | 2301 25th St S Fargo, ND - 581036104 |
| Business Phone Number: | 7014176222 |
| Business Fax Number: | |
| Mailing Address: | 2301 25th St S, FARGO |
| State: | ND |
| Postal Code: | 581036104 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2014 |
| NPI Last Update Date: | 09/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | 979 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |