Healthcare Provider Details

I. General information

NPI: 1528526894
Provider Name (Legal Business Name): MOVING MOUNTAINS THERAPY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 S RUSSELL ST STE B
MISSOULA MT
59801-8523
US

IV. Provider business mailing address

3031 S RUSSELL ST STE B
MISSOULA MT
59801-8523
US

V. Phone/Fax

Practice location:
  • Phone: 406-396-4130
  • Fax: 406-797-5008
Mailing address:
  • Phone: 406-396-4130
  • Fax: 406-797-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA LOUISE OLSOWOSKI
Title or Position: CO-OWNER
Credential: OTD,OTR/L
Phone: 406-396-4130