Healthcare Provider Details

I. General information

NPI: 1629203054
Provider Name (Legal Business Name): PEDIATRIC THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 BROADWATER AVE
BILLINGS MT
59101-2710
US

IV. Provider business mailing address

1610 POLY DR
BILLINGS MT
59102-1724
US

V. Phone/Fax

Practice location:
  • Phone: 406-259-1680
  • Fax: 406-259-1777
Mailing address:
  • Phone: 406-259-1680
  • Fax: 406-259-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TRACI L SELL
Title or Position: SLP/BCBA/OWNER
Credential: M.S. CCC-SLP, BCBA
Phone: 406-259-1680