Individual
KRISTEN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3169 S BOWN WAY, BOISE, ID 83706-5400
(208) 433-9152
(208) 344-4752
Mailing address
3169 S BOWN WAY, BOISE, ID 83706-5400
(208) 433-9152
(208) 344-4752
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-094
ID
Other
Enumeration date
12/10/2009
Last updated
12/10/2009
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