Healthcare Provider Details

I. General information

NPI: 1396101804
Provider Name (Legal Business Name): JAMES RAYMOND GUSTAFSON O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 HARRISON AVE STE 7
BUTTE MT
59701-7033
US

IV. Provider business mailing address

5050 HARRISON AVE STE 7
BUTTE MT
59701-7033
US

V. Phone/Fax

Practice location:
  • Phone: 406-792-1099
  • Fax: 406-601-8845
Mailing address:
  • Phone: 406-792-1099
  • Fax: 406-601-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4000
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: