Provider Demographics
NPI:1023175460
Name:SEIBOLD, CARISSA (MS,OTRL)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:SEIBOLD
Suffix:
Gender:F
Credentials:MS,OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 DELTA CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6817
Mailing Address - Country:US
Mailing Address - Phone:406-259-5320
Mailing Address - Fax:
Practice Address - Street 1:3940 RIMROCK RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0141
Practice Address - Country:US
Practice Address - Phone:406-655-5770
Practice Address - Fax:406-655-5639
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT883225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist