Individual
KAREN LEE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1220 MONTANA ST, 101, GOODING, ID 83330-1856
(208) 934-5601
Mailing address
4141 W NEZ PERCE ST, APT 324, BOISE, ID 83705-2959
(208) 919-4861
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1626
ID
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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