Healthcare Provider Details

I. General information

NPI: 1740100916
Provider Name (Legal Business Name): LUPINE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 BORA WAY
BOZEMAN MT
59718-3411
US

IV. Provider business mailing address

1599 BORA WAY
BOZEMAN MT
59718-3411
US

V. Phone/Fax

Practice location:
  • Phone: 309-558-5327
  • Fax:
Mailing address:
  • Phone: 309-558-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. HALEY RENEE HARRINGTON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L, CHT
Phone: 309-558-5327