Provider Demographics
NPI:1487079919
Name:GUENTHER, JARED (OT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:GUENTHER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2507
Mailing Address - Country:US
Mailing Address - Phone:406-771-3754
Mailing Address - Fax:406-761-1390
Practice Address - Street 1:1537 AVENUE D
Practice Address - Street 2:SUITE 111
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3048
Practice Address - Country:US
Practice Address - Phone:406-252-9600
Practice Address - Fax:406-252-0595
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-2723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist