Provider Demographics
NPI:1306296520
Name:WOOD, SEAN (COTA/L)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
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 1:108 N PONDERA AVE
Mailing Address - Street 2:APT B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6327
Mailing Address - Country:US
Mailing Address - Phone:406-218-1085
Mailing Address - Fax:
Practice Address - Street 1:205 N TRACY AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3564
Practice Address - Country:US
Practice Address - Phone:406-587-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OTA-LIC-4024224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant