Individual
MS. GLENDA KAY MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 E 17TH S. 400, IDAHO FALLS, ID 83404
(208) 589-0807
(208) 542-9577
Mailing address
185 W WOODHAVEN LN, IDAHO FALLS, ID 83404-8429
(208) 569-1882
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA204
ID
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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