| NPI | 1073204129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA E SHOTWELL Owner 208-271-6389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2024-07-18 |