Provider Demographics
NPI:1124294590
Name:RITLAND, MARCIE SHANTEL (COTA)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:SHANTEL
Last Name:RITLAND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2023
Mailing Address - Country:US
Mailing Address - Phone:406-628-8251
Mailing Address - Fax:406-628-8253
Practice Address - Street 1:820 3RD AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-2023
Practice Address - Country:US
Practice Address - Phone:406-628-8251
Practice Address - Fax:406-628-8253
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT310224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant