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Individual

ILLA STICE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3812 N TAMARACK DR, BOISE, ID 83703-4556
(307) 287-0356
Mailing address
3812 N TAMARACK DR, BOISE, ID 83703-4556

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1151
ID

Other

Enumeration date
06/27/2014
Last updated
06/27/2014
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