Provider Demographics
NPI:1851400667
Name:ISACCO, RON LUDWIG (OTR/L)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:LUDWIG
Last Name:ISACCO
Suffix:
Gender:M
Credentials:OTR/L
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 493
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59703-0493
Mailing Address - Country:US
Mailing Address - Phone:406-782-6607
Mailing Address - Fax:
Practice Address - Street 1:3718 E LAKE DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4314
Practice Address - Country:US
Practice Address - Phone:406-494-7050
Practice Address - Fax:406-494-7050
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT661570OtherBC/BS OF MONTANA
MT349537Medicaid
MTMSF1221385OtherSTATE FUND PROVIDER
MT50585Medicare ID - Type Unspecified