| NPI | 1609518166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA BLACK Occupational Therapist 208-669-3186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist Pediatrics |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |