Healthcare Provider Details

I. General information

NPI: 1255388229
Provider Name (Legal Business Name): LISA M SPORS-MURPHY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/27/2023
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 OSLOSKI RD
EUREKA MT
59917-9058
US

IV. Provider business mailing address

PO BOX 1456
EUREKA MT
59917-1456
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-3915
  • Fax: 406-297-3364
Mailing address:
  • Phone: 406-297-3915
  • Fax: 406-297-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number844
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: