Individual
JIMMY LOUIS BURKHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 W LACROSSE AVE, COEUR D ALENE, ID 83814-2403
(208) 664-2185
Mailing address
210 W LACROSSE AVE, COEUR D ALENE, ID 83814-2403
(208) 664-2185
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-196
ID
Other
Enumeration date
06/30/2014
Last updated
06/30/2014
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