Provider Demographics
NPI:1376844431
Name:FOSSEN, BARBARA MAUREEN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MAUREEN
Last Name:FOSSEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 N RESERVE ST STE D
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1395
Mailing Address - Country:US
Mailing Address - Phone:406-327-1827
Mailing Address - Fax:406-327-1697
Practice Address - Street 1:3055 N RESERVE ST STE D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1395
Practice Address - Country:US
Practice Address - Phone:406-327-1827
Practice Address - Fax:406-327-1697
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60099117225X00000X
MT1137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist