Individual
HOLLY MAURINE ST. JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
7 N 600 W, BLACKFOOT, ID 83221-5533
(208) 709-1200
Mailing address
58 E RICH LN, BLACKFOOT, ID 83221-5804
(208) 709-1200
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-995
ID
Other
Enumeration date
09/05/2011
Last updated
09/05/2011
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