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NPI Code Detail

MEDICARE: PEACH TREE ACADEMY

MEDICARE: PEACH TREE ACADEMY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2106E00000XAssistant Behavior Analyst
3106S00000XBehavior Technician
4225X00000XOccupational Therapist
5235Z00000XSpeech-Language Pathologist
6103K00000XBehavior Analyst

General Provider Information

NPI Number : 1063924330
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEACH TREE ACADEMY
Provider Business Mailing Address
First Line : 1091 STONERIDGE DR
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-7042
Country : US
Telephone Number : 406-624-6599
Fax Number :
Provider Business Practice Location Address
First Line : 1091 STONERIDGE DR
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-7042
Country : US
Telephone Number : 406-624-6599
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KRISTI EKSTROM
Credential :
Telephone Number : 406-624-6599
Provider Enumeration Date : 10/26/2017
Last Update Date : 09/08/2023

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Directions to “PEACH TREE ACADEMY ” Practice Location

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