Organization
SUPERSTARS OCCUPATIONAL THERAPY FOR KIDS, PLLC
Active
Organization
SUPERSTARS OCCUPATIONAL THERAPY FOR KIDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY JOHNSON (MANAGING MEMBER)
(208) 819-9363
Entity
Organization
Contact information
Practice address
2422 N. PARTRIDGE LOOP, POST FALLS, ID 83854-4944
(208) 819-9363
Mailing address
2422 N. PARTRIDGE LOOP, POST FALLS, ID 83854-4944
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
07/30/2008
Last updated
07/30/2008
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