Provider Demographics
NPI:1346309424
Name:KITTELSON-ALDRED, TAMARA LEE (MS, OTR, ATP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:KITTELSON-ALDRED
Suffix:
Gender:F
Credentials:MS, OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7022
Mailing Address - Country:US
Mailing Address - Phone:406-549-9521
Mailing Address - Fax:406-728-4190
Practice Address - Street 1:501 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7022
Practice Address - Country:US
Practice Address - Phone:406-549-9521
Practice Address - Fax:406-728-4190
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CA2400X
MT41225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT66205OtherBLUE CROSS BLUE SHIELD
MT344675Medicaid
MT0601681Medicaid
MT50584Medicare ID - Type Unspecified