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General NPI Number Information
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NPI Number | 1972705234
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Entity Type | Individual
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Provider Name | LYNNE L. HERSOM L.O.T.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 63 MAIN ST
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City | STEVENSVILLE
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State | MT
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Zip | 59870
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Country | US
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Telephone | 406-777-5411
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Fax |
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Provider Business Mailing Address
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Address Line | 402 S. 7TH ST.
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City | HAMILTON
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State | MT
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Zip | 59840
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Country | US
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Telephone | 406-363-1390
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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 | 1001
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License Number State | MT
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