Provider Demographics
NPI:1922345024
Name:FEDDES, AMY MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:FEDDES
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 1:111 N SHORE DR
Mailing Address - Street 2:#2
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9624
Mailing Address - Country:US
Mailing Address - Phone:406-570-3669
Mailing Address - Fax:
Practice Address - Street 1:129 VILLAGE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9618
Practice Address - Country:US
Practice Address - Phone:406-570-3669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist