Idaho Therapy Source

NPI #1235461732 in Nampa, Idaho

Provider Information

NPI Number: 1235461732
Entity Type: Organization
Organization Name: Idaho Therapy Source
Primary Specialty: Occupational Therapist
Enumeration Date: Feb 8, 2010
Last Updated: Feb 8, 2010

Practice Location

Address: 1812 N MIDLAND BLVD
City: Nampa
State: Idaho
ZIP Code: 83651-1747
Phone: (208) 412-6919

Authorized Official

Name: CHRISTINE M DICKENS, OT
Title: SOLE MEMBER/OT
Phone: (208) 467-9117

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X	Primary

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