MEDICARE: O THERAPY SERVICES, LLC

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	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-19762	MT
2	225X00000X	Occupational Therapist	704	MT

General Provider Information

NPI Number	:	1740597285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	820 HILDA AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-4332
Country	:	US
Telephone Number	:	406-239-5820
Fax Number	:	406-924-7292

Provider Business Practice Location Address
First Line	:	800 KENSINGTON AVE
Second Line	:	SUITE 100
City	:	MISSOULA
State	:	MT
Zip	:	59801-5674
Country	:	US
Telephone Number	:	406-239-5820
Fax Number	:	406-924-7292

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN MARGARET OBERG
Credential	:	OTR/L
Telephone Number	:	406-239-5820

Provider Enumeration Date	:	09/03/2010
Last Update Date	:	12/21/2016

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