Individual
TYLER EARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2303 PARK AVE, BURLEY, ID 83318-2106
(208) 677-3073
Mailing address
2303 PARK AVE, BURLEY, ID 83318-2106
(208) 677-3073
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1278
ID
Other
Enumeration date
12/30/2016
Last updated
12/30/2016
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