Organization
IDAHO THERAPY SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE M DICKENS OT (SOLE MEMBER/OT)
(208) 467-9117
Entity
Organization
Contact information
Practice address
1812 N MIDLAND BLVD, NAMPA, ID 83651-1747
(208) 412-6919
Mailing address
10984 W BOX CANYON ST, STAR, ID 83669-5691
(208) 412-6919
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-663
ID
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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