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General NPI Number Information
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NPI Number | 1215758339
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Entity Type | Organization
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Legal Business Name | CLARK FORK OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 901 SW HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59803-3600
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Country | US
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Telephone | 406-552-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 BURLINGTON AVE
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City | MISSOULA
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State | MT
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Zip | 59801-5254
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Country | US
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Telephone | 406-249-0302
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | SARAH MOORE
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Credential | OTD, OTR/L
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Telephone | 406-249-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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