Provider Demographics
NPI:1396450110
Name:ITOH, BRIAN (MS OTR)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ITOH
Suffix:
Gender:M
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CENTRAL AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3178
Mailing Address - Country:US
Mailing Address - Phone:406-579-7508
Mailing Address - Fax:
Practice Address - Street 1:1500 32ND ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5300
Practice Address - Country:US
Practice Address - Phone:406-761-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7636225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist