Provider Demographics
NPI:1093098733
Name:MONTANA SCHOOL OF MASSAGE
Entity Type:Organization
Organization Name:MONTANA SCHOOL OF MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:406-549-9244
Mailing Address - Street 1:1629 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7803
Mailing Address - Country:US
Mailing Address - Phone:406-549-9244
Mailing Address - Fax:406-549-7260
Practice Address - Street 1:1629 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7803
Practice Address - Country:US
Practice Address - Phone:406-549-9244
Practice Address - Fax:406-549-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBL20070456302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization