Provider Demographics
NPI:1306946314
Name:NELSON, GLORIA IRENE (OTR/L)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:IRENE
Last Name:NELSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:IRENE
Other - Last Name:SPEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:711 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2964
Mailing Address - Country:US
Mailing Address - Phone:406-862-9378
Mailing Address - Fax:406-862-9882
Practice Address - Street 1:711 E 13TH ST
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2964
Practice Address - Country:US
Practice Address - Phone:406-862-9378
Practice Address - Fax:406-862-9882
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT970225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist