Individual
SONIA LYNN PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
40 HAWTHORN AVE, KALISPELL, MT 59901-3404
(406) 212-2005
Mailing address
40 HAWTHORN AVE, KALISPELL, MT 59901-3404
(406) 212-2005
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
902
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3400683
—
MT
Enumeration date
06/11/2007
Last updated
07/09/2007
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