# IDAHO THERAPY SOURCE

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

## Provider details

- **NPI number:** 1235461732
- **Authorized official:** CHRISTINE M DICKENS OT (SOLE MEMBER/OT)
- **Authorized official phone:** (208) 467-9117

## Contact information

- **Practice address:** 1812 N MIDLAND BLVD, NAMPA, ID 83651-1747
- **Practice address phone:** (208) 412-6919
- **Mailing address:** 10984 W BOX CANYON ST, STAR, ID 83669-5691
- **Mailing address phone:** (208) 412-6919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | OT-663 | ID | Yes |

## Other

- **Enumeration date:** 02/08/2010
- **Last updated:** 02/08/2010