Healthcare Provider Details

I. General information

NPI: 1588432934
Provider Name (Legal Business Name): JOHNA DHUYVETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 SOUTH AVE W
MISSOULA MT
59804-6405
US

IV. Provider business mailing address

8100 SW NYBERG ST STE 200
TUALATIN OR
97062-8437
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-9162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: