Provider Demographics
NPI:1730492430
Name:CANNON, KARA LEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:LEE
Last Name:CANNON
Suffix:
Gender:F
Credentials: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:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-1752
Mailing Address - Country:US
Mailing Address - Phone:406-600-8366
Mailing Address - Fax:406-284-2210
Practice Address - Street 1:517 TIMBERVIEW CIR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8288
Practice Address - Country:US
Practice Address - Phone:406-600-8366
Practice Address - Fax:406-284-2210
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2766225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics