Individual
MRS. JAN ELIZABETH FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T., L.A.C.
Contact information
Practice address
1730 GAYLORD ST, BUTTE, MT 59701-5398
(406) 560-3497
Mailing address
1730 GAYLORD ST, BUTTE, MT 59701-5398
(406) 560-3497
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1067
MT
225XP0200X
Pediatric Occupational Therapist
887
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0037245
—
MT
01
—
1067
ADDICTION COUNSELOR
MT
01
—
887
OCCUPATIONAL THERAPIST
MT
Enumeration date
12/15/2006
Last updated
09/11/2025
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