Individual
LEEANNE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 489-4444
Mailing address
11880 W EDNA ST, BOISE, ID 83713-3643
(208) 377-1060
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-714
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-714
BUREAU OF OCCUPATIONAL LICENSES IDAHO
ID
Enumeration date
03/06/2014
Last updated
03/06/2014
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