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Organization
EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Active
Organization
EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SHERMAN (CFO)
(406) 771-3762
Entity
Organization
Contact information
Practice address
350 S 400 E, SALT LAKE CITY, UT 84111-2908
(801) 946-1860
Mailing address
425 1ST AVE N, GREAT FALLS, MT 59401-2507
(406) 771-3754
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
NULL
225X00000X
Occupational Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
—
NULL
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
08/11/2010
Last updated
03/26/2019
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