Individual
JENNIFER LONGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3169 S BOWN WAY, BOISE, ID 83706-5400
(208) 433-9152
Mailing address
3169 S BOWN WAY, BOISE, ID 83706-5400
(208) 433-9152
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2173
ID
Other
Enumeration date
03/10/2020
Last updated
03/10/2020
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