Provider Demographics
NPI:1861563199
Name:GREGG ROSS, ANN RENEE (OTR)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:RENEE
Last Name:GREGG ROSS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 SPURGIN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-3110
Mailing Address - Country:US
Mailing Address - Phone:406-327-7402
Mailing Address - Fax:406-327-7402
Practice Address - Street 1:2842 SPURGIN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-3110
Practice Address - Country:US
Practice Address - Phone:406-327-7402
Practice Address - Fax:406-327-7402
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT33225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0347786Medicaid