Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1598380644 |
---|---|
Provider Name | Chris Siller |
First Address | Missoula, MT 59801-2422 |
Second Address | Missoula, MT 59801-2422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2020 |
Last Update Date | 31/07/2020 |