Individual
KC AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
527 MEMORIAL DR, POCATELLO, ID 83201-4063
(208) 478-3343
(208) 478-3329
Mailing address
527 MEMORIAL DR, POCATELLO, ID 83201-4063
(208) 478-3343
(208) 478-3329
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-878
ID
225XN1300X
Neurorehabilitation Occupational Therapist
OT-878
ID
Other
Enumeration date
09/08/2008
Last updated
09/08/2008
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