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General NPI Number Information
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NPI Number | 1659198976
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Entity Type | Organization
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Legal Business Name | OT HAVEN
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 483 S 44TH ST W APT 4110
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City | BILLINGS
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State | MT
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Zip | 59106-3974
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Country | US
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Telephone | 406-534-9064
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 24TH ST W
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City | BILLINGS
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State | MT
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Zip | 59102-3861
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Country | US
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Telephone | 406-534-9064
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA LEIGH DOUGHERTY
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Credential | OT
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Telephone | 406-534-9064
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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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