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General NPI Number Information
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NPI Number | 1790639649
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Entity Type | Organization
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Legal Business Name | BLUEBIRD HOLISTIC THERAPY
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 311 E COEUR D ALENE AVE STE C
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4965
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Country | US
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Telephone | 208-551-1575
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Fax |
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Provider Business Mailing Address
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Address Line | 12208 N DIAMOND DR
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City | HAYDEN
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State | ID
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Zip | 83835-7909
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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 | OWNER/OCCUPATIONAL THERAPIST
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Name | JANA MARIE MONTGOMERY
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Credential | OTR/L
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Telephone | 208-551-1575
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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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