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Individual

MRS. CHERYL E RODNICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR L, CHT

Contact information

Practice address
1950 E CLARK ST, STF, POCATELLO, ID 83201-3314
(208) 232-2915
(208) 232-5553
Mailing address
1950 E CLARK ST, STF, POCATELLO, ID 83201-3314
(208) 232-2519
(208) 232-5553

Taxonomy

Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
OT-209
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010023189
REGENCE OF ID
ID
01
W0533
BLUE CROSS
ID
Enumeration date
04/21/2006
Last updated
07/09/2007
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