Provider Demographics
NPI:1578087854
Name:OSTROWSKI, TANA SUE (OTA/L, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:TANA
Middle Name:SUE
Last Name:OSTROWSKI
Suffix:
Gender:F
Credentials:OTA/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3753
Mailing Address - Country:US
Mailing Address - Phone:406-546-9277
Mailing Address - Fax:
Practice Address - Street 1:3018 RATTLESNAKE DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-6101
Practice Address - Country:US
Practice Address - Phone:406-549-0988
Practice Address - Fax:406-549-0111
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OTA-LIC-292224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant