Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | ||
N | 225X00000X | Occupational Therapist | 41 | MT |
NPI | 1346309424 |
---|---|
Provider Name | Tamara Lee Kittelson-Aldred |
First Address | Missoula, MT 59801-7022 |
Second Address | Missoula, MT 59801-7022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0601681 | (05) | MT |
344675 | (05) | MT |
66205 | BLUE CROSS BLUE SHIELD (01) | MT |