Healthcare Provider Details

I. General information

NPI: 1982970216
Provider Name (Legal Business Name): CHRISTAL KATHERINE PETERS MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 7TH AVE S STE C4
GREAT FALLS MT
59405-3031
US

IV. Provider business mailing address

1024 17TH AVE SW
GREAT FALLS MT
59404-3422
US

V. Phone/Fax

Practice location:
  • Phone: 406-216-5995
  • Fax:
Mailing address:
  • Phone: 406-579-9567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1155
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: