Provider Demographics
NPI:1235364621
Name:LEWIS-BURDA, PIXIE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:PIXIE
Middle Name:MARIE
Last Name:LEWIS-BURDA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HIDEAWAY TRL
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-8933
Mailing Address - Country:US
Mailing Address - Phone:406-222-4673
Mailing Address - Fax:
Practice Address - Street 1:601 ROBIN LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3810
Practice Address - Country:US
Practice Address - Phone:406-222-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1017932224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant