# LULLABY WATERS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114342755
- **Authorized official:** NICOLE NICKELL (OWNER)
- **Authorized official phone:** (208) 949-3481

## Contact information

- **Practice address:** 1410 S BROADWAY AVE, BOISE, ID 83706-3706
- **Practice address phone:** (208) 949-3481
- **Mailing address:** 179 E OLD SAYBROOK DR, BOISE, ID 83706-4918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | OT-1014 | ID | Yes |

## Other

- **Enumeration date:** 02/19/2014
- **Last updated:** 07/13/2021