Healthcare Provider Details

I. General information

NPI: 1669335303
Provider Name (Legal Business Name): KELSEY HOGART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 3RD AVE
LAUREL MT
59044-2023
US

IV. Provider business mailing address

320 YELLOWSTONE AVE
LAUREL MT
59044-3243
US

V. Phone/Fax

Practice location:
  • Phone: 406-628-8251
  • Fax:
Mailing address:
  • Phone: 406-491-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTP-OT-LIC-5457
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: