| NPI | 1427536614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA PETERSON Owner 208-584-1141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2018-08-01 |