Provider Demographics
NPI:1194861914
Name:JURGENS, KARI MARIAH (OTR)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:MARIAH
Last Name:JURGENS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 WHITEFISH STAGE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8486
Mailing Address - Country:US
Mailing Address - Phone:406-863-9204
Mailing Address - Fax:
Practice Address - Street 1:4780 WHITEFISH STAGE RD
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8486
Practice Address - Country:US
Practice Address - Phone:406-863-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT839225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT660960OtherOT BCBS NUMBER
MT0348755Medicaid