Individual
LORI ANN GRABER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.O.T O.T.R.
Contact information
Practice address
1130 ALLUMBAUGH ST, BOISE, ID 83704-8700
(208) 854-8517
(208) 854-8689
Mailing address
PO BOX 6495, BOISE, ID 83707-6495
(208) 854-8517
(208) 854-8689
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
795
ID
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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