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NPI Code Detail

MEDICARE: PEDIATRIC THERAPY CLINIC

MEDICARE: PEDIATRIC THERAPY CLINIC
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
1261QH0700XHearing and Speech Clinic/Center
2224ZF0002XFeeding, Eating & Swallowing Occupational Therapy Assistant
3225100000XPhysical Therapist
42251P0200XPediatric Physical Therapist
5225X00000XOccupational Therapist
6225XP0200XPediatric Occupational Therapist
7235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1629203054
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC THERAPY CLINIC
Provider Business Mailing Address
First Line : 1610 POLY DR
Second Line :
City : BILLINGS
State : MT
Zip : 59102-1724
Country : US
Telephone Number : 406-259-1680
Fax Number : 406-259-1777
Provider Business Practice Location Address
First Line : 708 BROADWATER AVE
Second Line :
City : BILLINGS
State : MT
Zip : 59101-2710
Country : US
Telephone Number : 406-259-1680
Fax Number : 406-259-1777
Authorized Official
Title or Position : SLP/BCBA/OWNER
Name : MR. TRACI L SELL
Credential : M.S. CCC-SLP, BCBA
Telephone Number : 406-259-1680
Provider Enumeration Date : 05/29/2009
Last Update Date : 12/19/2018

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1720116882 — MRS. TRACI LYNN SELL M.S. CCC-SLP, BCBA
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1063858306 — KATY ANN HARMAN M.S.CCC-SLP
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Directions to “PEDIATRIC THERAPY CLINIC ” Practice Location

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