Healthcare Provider Details

I. General information

NPI: 1700543881
Provider Name (Legal Business Name): NICOLE DANAE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 2ND ST E STE 209
KALISPELL MT
59901-4500
US

IV. Provider business mailing address

PO BOX 11291
KALISPELL MT
59904-4291
US

V. Phone/Fax

Practice location:
  • Phone: 406-885-2974
  • Fax:
Mailing address:
  • Phone: 406-885-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-16232
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: