Individual
MRS. JORDAN RENEE HATFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 11TH AVE S, NAMPA, ID 83651-3918
(208) 466-1077
Mailing address
2916 N ARTHUR ST, BOISE, ID 83703-4834
(980) 395-2932
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2109
ID
Other
Enumeration date
12/10/2019
Last updated
12/10/2019
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