Provider Demographics
NPI:1194570937
Name:LUNDEBREK, AVERI ASHTON (OTR/L)
Entity type:Individual
Prefix:
First Name:AVERI
Middle Name:ASHTON
Last Name:LUNDEBREK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AVERI
Other - Middle Name:ASHTON
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 W MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-7501
Mailing Address - Country:US
Mailing Address - Phone:701-330-8812
Mailing Address - Fax:
Practice Address - Street 1:816 W MIDWAY DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-7501
Practice Address - Country:US
Practice Address - Phone:701-330-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist