Provider Demographics
NPI:1972660835
Name:KITZENBERG, PAULA HUBER (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:HUBER
Last Name:KITZENBERG
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0349
Mailing Address - Country:US
Mailing Address - Phone:406-690-3523
Mailing Address - Fax:406-652-3798
Practice Address - Street 1:3510 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0349
Practice Address - Country:US
Practice Address - Phone:406-690-3523
Practice Address - Fax:406-652-3798
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT315225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT662600OtherBLUE CROSS BLUE SHIELD
MT3402040Medicaid