Provider Demographics
NPI:1306106638
Name:SANDVIG, JULIE ANN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SANDVIG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3060 FRONTIER WAY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8909
Mailing Address - Country:US
Mailing Address - Phone:701-232-2340
Mailing Address - Fax:
Practice Address - Street 1:4501 COLEMAN ST STE 103
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0996
Practice Address - Country:US
Practice Address - Phone:701-751-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60282924225X00000X
CA104223225X00000X
ND225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463044Medicaid