MEDICARE: JULIA ANNE FAWCETT O.T.

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
1	225X00000X	Occupational Therapist	1048	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1048	OTHER	MT	OCCUPATIONAL THERAPIST

General Provider Information

NPI Number	:	1649435397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA ANNE FAWCETT O.T.

Provider Business Mailing Address
First Line	:	63 MAIN ST
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2122
Country	:	US
Telephone Number	:	406-777-5411
Fax Number	:	406-777-5856

Provider Business Practice Location Address
First Line	:	63 MAIN ST
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2122
Country	:	US
Telephone Number	:	406-777-5411
Fax Number	:	406-777-5856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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