Provider Demographics
NPI:1689958522
Name:BLOM, MEG (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MEG
Middle Name:
Last Name:BLOM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4550
Mailing Address - Country:US
Mailing Address - Phone:406-449-7458
Mailing Address - Fax:406-443-7496
Practice Address - Street 1:1732 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4550
Practice Address - Country:US
Practice Address - Phone:406-449-7458
Practice Address - Fax:406-443-7496
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT28225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist