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1710460423
BROOKE LEIGH BLANCHARD
POCATELLO, ID
NPI
1710460423
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: ID OTA-1965)
Enumeration Date
2018-09-09
Last Update Date
2018-09-09
Business Address
BROOKE LEIGH BLANCHARD COTA
1957 ALVIN RICKEN DR
POCATELLO, ID 83201-2727
Phone number: 208-235-7800
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Mailing Address
BROOKE LEIGH BLANCHARD COTA
25117 SW PARKWAY AVE STE D
WILSONVILLE, OR 97070-9697
Phone number:
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