Individual
MRS. KATHRYN BRODERIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
316 E 1ST ST, MIDDLETON, ID 83644-6159
(208) 654-6161
Mailing address
3700 E DOWNS AVE, NAMPA, ID 83686-1385
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2455
ID
225XP0200X
Pediatric Occupational Therapist
OT-2455
ID
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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