| NPI | 1417577693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL RENE' BUTGEREIT Executive Director 208-949-3315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2020-04-17 |