Healthcare Provider Details

I. General information

NPI: 1760309330
Provider Name (Legal Business Name): EMMA GAENZLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 N 14TH AVE STE 101
BOZEMAN MT
59715-3270
US

IV. Provider business mailing address

649 MATHESON WAY
BOZEMAN MT
59715-3214
US

V. Phone/Fax

Practice location:
  • Phone: 585-967-5483
  • Fax:
Mailing address:
  • Phone: 585-967-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14927
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: