Provider Demographics
NPI:1649449299
Name:COOK-BRETSON, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:COOK-BRETSON
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:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-2021
Mailing Address - Country:US
Mailing Address - Phone:406-600-4041
Mailing Address - Fax:
Practice Address - Street 1:421 W MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3448
Practice Address - Country:US
Practice Address - Phone:406-600-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT214225700000X
MTMED-ACU-LIC-58960171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-ACU-LIC-58960OtherMONTANA STATE ACUPUNCTURE
537979-07OtherNCBTMB
MT214OtherMASSAGE THERAPIST