Individual
CHELSEA JOAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
1460 ELK CREEK DR, IDAHO FALLS, ID 83404-8237
(128) 620-8535
Mailing address
767 N COLORADO AVE, IDAHO FALLS, ID 83402-1841
(208) 871-2484
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1920
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1920
NONE
ID
Enumeration date
09/20/2021
Last updated
09/20/2021
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