Provider Demographics
NPI:1386252377
Name:ROLFSON, MADISYN (OTR/L)
Entity type:Individual
Prefix:
First Name:MADISYN
Middle Name:
Last Name:ROLFSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADISYN
Other - Middle Name:
Other - Last Name:RICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6110
Mailing Address - Country:US
Mailing Address - Phone:701-205-4194
Mailing Address - Fax:
Practice Address - Street 1:3120 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6110
Practice Address - Country:US
Practice Address - Phone:701-205-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1797225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist