Healthcare Provider Details

I. General information

NPI: 1720582877
Provider Name (Legal Business Name): LAUREL KRISTIAN REDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 S. 3RD ST. W
MISSOULA MT
59801-3328
US

IV. Provider business mailing address

1280 S. 3RD ST. W
MISSOULA MT
59801-3328
US

V. Phone/Fax

Practice location:
  • Phone: 406-830-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTP-OT-LIC-10429
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: