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General NPI Number Information
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NPI Number | 1720582877
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Entity Type | Individual
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Provider Name | LAUREL KRISTIAN REDMOND
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 1280 S. 3RD ST. W
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City | MISSOULA
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State | MT
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Zip | 59801-3328
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Country | US
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Telephone | 406-830-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1280 S. 3RD ST. W
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City | MISSOULA
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State | MT
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Zip | 59801-3328
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTP-OT-LIC-10429
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License Number State | MT
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