Healthcare Provider Details

I. General information

NPI: 1306908785
Provider Name (Legal Business Name): STEVEN WALLACE FUGERE OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WEST 21ST STR.
RED LODGE MT
59068
US

IV. Provider business mailing address

PO BOX 1611
RED LODGE MT
59068-1611
US

V. Phone/Fax

Practice location:
  • Phone: 406-466-1112
  • Fax: 406-446-0082
Mailing address:
  • Phone: 406-446-2345
  • Fax: 406-446-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number975
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: