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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