KRISTOPHER DWAYNE WALLIN

BOISE, ID
NPI1205215274
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: ID  OTA-1423)
Enumeration Date2015-05-24
Last Update Date2015-05-24
Business Address
Mr. KRISTOPHER DWAYNE WALLIN COTA/L
8211 W USTICK RD
BOISE, ID 83704-5756
Phone number: 208-375-3700
Mailing Address
Mr. KRISTOPHER DWAYNE WALLIN COTA/L
979 E ENSOLORADO ST
KUNA, ID 83634-5179
Phone number: 208-608-0809
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