MEDICARE: MRS. DIANE SHIRLEY MORLEDGE HAM OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XL0004X	Low Vision Occupational Therapist	278	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	278	OTHER	MT	MONTANA STATE LICENSE

General Provider Information

NPI Number	:	1023257821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE SHIRLEY MORLEDGE HAM OTR/L

Provider Business Mailing Address
First Line	:	2520 17TH ST W
Second Line	:	SUITE 103
City	:	BILLINGS
State	:	MT
Zip	:	59102-1738
Country	:	US
Telephone Number	:	406-294-1994
Fax Number	:	406-294-1996

Provider Business Practice Location Address
First Line	:	2520 17TH ST W
Second Line	:	SUITE 103
City	:	BILLINGS
State	:	MT
Zip	:	59102-1738
Country	:	US
Telephone Number	:	406-294-1994
Fax Number	:	406-294-1996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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