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NPI Code Detail

MEDICARE: MELISSA HAIDLE

MEDICARE: MELISSA HAIDLE
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
1225X00000XOccupational Therapist3934MT

General Provider Information

NPI Number : 1093184897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA HAIDLE
Provider Business Mailing Address
First Line : 1140 VILLAGE WAY
Second Line :
City : MISSOULA
State : MT
Zip : 59802-2967
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 E BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4905
Country : US
Telephone Number : 406-721-0680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2015
Last Update Date : 12/15/2020

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Directions to “ MELISSA HAIDLE ” Practice Location

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