Provider Demographics
NPI:1730394651
Name:TRACY HAND & OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:TRACY HAND & OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:406-752-7581
Mailing Address - Street 1:111 SUNNYVIEW LN STE C
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-7581
Mailing Address - Fax:406-752-7584
Practice Address - Street 1:111 SUNNYVIEW LN STE C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3164
Practice Address - Country:US
Practice Address - Phone:406-752-7581
Practice Address - Fax:406-752-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT178332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0345117Medicaid
MT3917170001Medicare NSC
MT0345117Medicaid