Individual
MARYANNE KLEVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
500 W AQUA AVE, COEUR D ALENE, ID 83815-7764
(208) 762-1122
Mailing address
8201 W BORDON CT, RATHDRUM, ID 83858-6496
(208) 651-5505
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT-731
ID
Other
Enumeration date
05/12/2008
Last updated
05/12/2008
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