MEDICARE: CASSIDY NORICK OTR/L

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	OTP-OT-LIC-12571	MT
2	225XP0200X	Pediatric Occupational Therapist	OTP-OT-LIC-12571	MT

General Provider Information

NPI Number	:	1720961725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY NORICK OTR/L

Provider Business Mailing Address
First Line	:	285 SKY RIDGE LN
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-9381
Country	:	US
Telephone Number	:	406-897-4687
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 SKY RIDGE LN
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-9381
Country	:	US
Telephone Number	:	406-897-4687
Fax Number	:

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

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	12/05/2025

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