Individual
MARINA MARIE OTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2707 N FRUITLAND LN APT C15, COEUR D ALENE, ID 83815-9374
(208) 664-9407
Mailing address
2707 N FRUITLAND LN APT C15, COEUR D ALENE, ID 83815-9374
(208) 664-9407
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
372600000X
Adult Companion
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
02/17/2010
Last updated
02/17/2010
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