Individual
HEATHER RAE CORDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 489-4444
Mailing address
622 ZOE LN, GARDEN CITY, ID 83714-4702
(208) 908-0963
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-123
ID
Other
Enumeration date
05/17/2012
Last updated
05/17/2012
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