Provider Demographics
NPI:1952634032
Name:REVELL, TERRI Z
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:Z
Last Name:REVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 352
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935-0352
Mailing Address - Country:US
Mailing Address - Phone:406-291-3014
Mailing Address - Fax:800-878-7249
Practice Address - Street 1:101 N KOOTENAI DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MT
Practice Address - Zip Code:59935
Practice Address - Country:US
Practice Address - Phone:406-291-3014
Practice Address - Fax:800-878-7249
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other