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Individual

MICHELLE FENN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.ED, LMT, MLDI

Contact information

Practice address
12071 W FLORIDA DR, BOISE, ID 83709-1157
(208) 757-2273
Mailing address
PO BOX 191072, BOISE, ID 83719-1072
(208) 757-2273

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2422
ID

Other

Enumeration date
12/26/2015
Last updated
12/26/2015
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