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General NPI Number Information
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NPI Number | 1306908785
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Entity Type | Individual
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Provider Name | STEVEN WALLACE FUGERE OTR
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 WEST 21ST STR.
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City | RED LODGE
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State | MT
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Zip | 59068
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Country | US
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Telephone | 406-466-1112
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Fax | 406-446-0082
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Provider Business Mailing Address
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Address Line | PO BOX 1611
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City | RED LODGE
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State | MT
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Zip | 59068-1611
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Country | US
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Telephone | 406-446-2345
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Fax | 406-446-0082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 975
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License Number State | MT
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