Healthcare Provider Details

I. General information

NPI: 1811391873
Provider Name (Legal Business Name): SUMMER WELSH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 INDIAN CREEK RD
EUREKA MT
59917-9110
US

IV. Provider business mailing address

P.O. BOX 55
EUREKA MT
59917
US

V. Phone/Fax

Practice location:
  • Phone: 406-291-2613
  • Fax:
Mailing address:
  • Phone: 406-291-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTP-OTA-LIC-1153
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-20047
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: