Provider Demographics
NPI:1215549829
Name:ORTEGA, JOLYN (C-IAYT)
Entity Type:Individual
Prefix:MRS
First Name:JOLYN
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:C-IAYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 GRANARY RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8748
Mailing Address - Country:US
Mailing Address - Phone:406-531-7110
Mailing Address - Fax:
Practice Address - Street 1:2539 GRANARY RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-8748
Practice Address - Country:US
Practice Address - Phone:406-531-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist