Provider Demographics
NPI:1366506966
Name:MIKLOS, DIANNE MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:MARIE
Last Name:MIKLOS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3033
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903
Mailing Address - Country:US
Mailing Address - Phone:406-752-0330
Mailing Address - Fax:406-752-0930
Practice Address - Street 1:80 FOUR MILE DR STE 14A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2665
Practice Address - Country:US
Practice Address - Phone:406-752-0330
Practice Address - Fax:406-752-0930
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT66069OtherBCBS MT
MT0349690Medicaid
MT670002252OtherRAILROAD MEDICARE
MT670002252OtherRAILROAD MEDICARE