Individual
JENNY FLINT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(555) 555-5555
Mailing address
7591 S DOME PEAK, LITTLETON, CO 80127-3823
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2047
ID
Other
Enumeration date
04/15/2019
Last updated
04/15/2019
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