| NPI | 1245400498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY OLDENKAMP Administrator 208-455-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist |
| Additional Taxonomies | 225XP0200X Occupational Therapist Pediatrics |
| 2251P0200X Physical Therapist Pediatrics | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |