1336251602 NPI number — MS. MARY KAYE PIERCE OTR, CHT

Table of content: MS. MARY KAYE PIERCE OTR, CHT (NPI 1336251602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336251602 NPI number — MS. MARY KAYE PIERCE OTR, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERCE
Provider First Name:
MARY KAYE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336251602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59903-5718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-756-0134
Provider Business Mailing Address Fax Number:
406-300-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 HEALTH PARK DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-666-2690
Provider Business Practice Location Address Fax Number:
303-665-1078
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  AA343426 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: OT0000890 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)