Healthcare Provider Details

I. General information

NPI: 1710087978
Provider Name (Legal Business Name): TIMOTHY MICHAEL TRACY OT CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOWER VALLEY RD
KALISPELL MT
59901-7921
US

IV. Provider business mailing address

25 HERITAGE WAY
KALISPELL MT
59901-3100
US

V. Phone/Fax

Practice location:
  • Phone: 406-300-4847
  • Fax:
Mailing address:
  • Phone: 406-407-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number178
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: