Provider Demographics
NPI:1023257821
Name:SHIRLEY MORLEDGE HAM, DIANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:SHIRLEY MORLEDGE HAM
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 1:2520 17TH ST W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1738
Mailing Address - Country:US
Mailing Address - Phone:406-294-1994
Mailing Address - Fax:406-294-1996
Practice Address - Street 1:2520 17TH ST W
Practice Address - Street 2:SUITE 103
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1738
Practice Address - Country:US
Practice Address - Phone:406-294-1994
Practice Address - Fax:406-294-1996
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT278225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT278OtherMONTANA STATE LICENSE