Provider Demographics
NPI:1629203054
Name:PEDIATRIC THERAPY CLINIC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/BCBA/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, BCBA
Authorized Official - Phone:406-259-1680
Mailing Address - Street 1:1610 POLY DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1724
Mailing Address - Country:US
Mailing Address - Phone:406-259-1680
Mailing Address - Fax:406-259-1777
Practice Address - Street 1:708 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2710
Practice Address - Country:US
Practice Address - Phone:406-259-1680
Practice Address - Fax:406-259-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & SwallowingGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty