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General NPI Number Information
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NPI Number | 1609158039
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Entity Type | Individual
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Provider Name | MICHAEL J SHAE MOTR/L
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Gender | Male
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 400 VETERAN'S DRIVE
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-0250
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Country | US
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Telephone | 406-892-3256
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Fax | 406-892-0143
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Provider Business Mailing Address
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Address Line | 1683 STAG LN
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City | KALISPELL
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State | MT
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Zip | 59901-5160
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Country | US
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Telephone |
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Fax |
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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 | 1070
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License Number State | MT
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