| NPI | 1023487105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARESA BLACK Occupational Therapist And Owner 208-627-8615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: ID OT-1405) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2022-06-01 |