Individual
LAURA SOPHIA LIEDTKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1207 MCDONALD AVE APT B, MISSOULA, MT 59801-9109
(406) 370-7176
Mailing address
1207 MCDONALD AVE APT B, MISSOULA, MT 59801-9109
Taxonomy
Speciality
Code
Description
License number
State
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
1127
MT
225XP0200X
Pediatric Occupational Therapist
Primary
1127
MT
225XP0200X
Pediatric Occupational Therapist
OT 00003449
WA
Other
Enumeration date
06/01/2011
Last updated
06/01/2011
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