Healthcare Provider Details

I. General information

NPI: 1548125180
Provider Name (Legal Business Name): LIVE WELL OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 S 7TH ST W
MISSOULA MT
59804
US

IV. Provider business mailing address

3019 S 7TH ST W
MISSOULA MT
59804
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-6118
  • Fax:
Mailing address:
  • Phone: 406-404-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY BROWN
Title or Position: PRACTICE OWNER
Credential: OTR/L
Phone: 406-404-6118