Provider Demographics
NPI:1992992341
Name:WINJUM, AMY JO (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:JO
Last Name:WINJUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3585 BUCHANAN ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7508
Mailing Address - Country:US
Mailing Address - Phone:701-388-4604
Mailing Address - Fax:218-233-0003
Practice Address - Street 1:150 COUNTY RD 34
Practice Address - Street 2:ARTHUR GOOD SAMARITAN CENTER
Practice Address - City:ARTHUR
Practice Address - State:ND
Practice Address - Zip Code:58006-4100
Practice Address - Country:US
Practice Address - Phone:701-967-8316
Practice Address - Fax:701-967-8961
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND792225X00000X
MN103188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist