Individual
LESLEE B TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1906 FAIRVIEW AVE STE 330, CALDWELL, ID 83605-5425
(208) 385-3680
Mailing address
11676 RICHMOND ST, CALDWELL, ID 83605-6047
(208) 340-0085
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OCTAA-2861
ID
Other
Enumeration date
08/01/2023
Last updated
08/01/2023
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