Individual
HALLIE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
608 N ROSS ST, BOISE, ID 83702-3816
(865) 201-7272
Mailing address
608 N ROSS ST, BOISE, ID 83702-3816
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
84116
TN
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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