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General NPI Number Information
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NPI Number | 1447423975
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Entity Type | Organization
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Legal Business Name | SWEET MEDICINE THERAPY LLC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 435 S ATLANTIC ST SUITE 104
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City | DILLON
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State | MT
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Zip | 59725-2726
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Country | US
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Telephone | 406-683-4453
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Fax | 406-683-4453
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Provider Business Mailing Address
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Address Line | 435 S ATLANTIC ST SUITE 104
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City | DILLON
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State | MT
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Zip | 59725-2726
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Country | US
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Telephone | 406-683-4453
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Fax | 406-683-4453
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Authorized Official
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Title or Position | OWNER
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Name | MS. DOROTHY ELIZABETH DEHART
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Credential | OTR
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Telephone | 406-683-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 524
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License Number State | MT
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