Organization
LULLABY WATERS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE NICKELL (OWNER)
(208) 949-3481
Entity
Organization
Contact information
Practice address
1410 S BROADWAY AVE, BOISE, ID 83706-3706
(208) 949-3481
Mailing address
179 E OLD SAYBROOK DR, BOISE, ID 83706-4918
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1014
ID
Other
Enumeration date
02/19/2014
Last updated
07/13/2021
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