Provider Demographics
NPI:1477877637
Name:INNOVATIVE REHABILITATION SERVICES
Entity Type:Organization
Organization Name:INNOVATIVE REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:406-248-7201
Mailing Address - Street 1:2351 SOLOMON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102
Mailing Address - Country:US
Mailing Address - Phone:406-656-3042
Mailing Address - Fax:406-651-1589
Practice Address - Street 1:2351 SOLOMON AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2879
Practice Address - Country:US
Practice Address - Phone:406-656-3042
Practice Address - Fax:406-651-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT124224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty