| NPI | 1609019025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIE ANN LEWIS Member 208-870-9811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: CO 831) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2009-04-15 |