Provider Demographics
NPI:1164981718
Name:CAPOUCH, TENIKA (OT)
Entity Type:Individual
Prefix:
First Name:TENIKA
Middle Name:
Last Name:CAPOUCH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21152
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1152
Mailing Address - Country:US
Mailing Address - Phone:406-647-0042
Mailing Address - Fax:406-204-7933
Practice Address - Street 1:1601 LEWIS AVE STE 107
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4182
Practice Address - Country:US
Practice Address - Phone:406-647-0042
Practice Address - Fax:406-204-7933
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist