Healthcare Provider Details

I. General information

NPI: 1376089441
Provider Name (Legal Business Name): ADDISON ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 AMHERST AVE
BUTTE MT
59701-4653
US

IV. Provider business mailing address

2717 LOCUST ST
BUTTE MT
59701-5030
US

V. Phone/Fax

Practice location:
  • Phone: 406-494-7035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTP-OT-TMP-4680
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: