Individual
LACEY JORDAN HUNTINGTON LUBENOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
2020 GILKERSON DR, BOZEMAN, MT 59715-2558
(406) 587-2755
Mailing address
4370 GLENWOOD DR, BOZEMAN, MT 59718-6370
(208) 406-8745
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTP-OT-LIC-6882
MT
Other
Enumeration date
07/31/2019
Last updated
01/08/2020
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