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Individual

ROBIN RUTHERFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
527 MEMORIAL DR, POCATELLO, ID 83201-4063
(208) 478-3333
Mailing address
1936 E CENTER ST, POCATELLO, ID 83201-3309
(208) 965-1071

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
N16A00147165
ID

Other

Enumeration date
12/29/2016
Last updated
12/29/2016
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