Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ||
N | 225X00000X | Occupational Therapist | OTP-OT-LIC-5368 | MT |
NPI | 1386205508 |
---|---|
Provider Name | Rebecca Masterjohn |
First Address | Kalispell, MT 59901-6093 |
Second Address | Kalispell, MT 59901-6093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |