Individual
TAMMY SUE CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
36 PROFESSIONAL PLZ STE 110, REXBURG, ID 83440-2049
(208) 359-9570
Mailing address
PO BOX 711, REXBURG, ID 83440-0711
(208) 359-9570
(208) 359-9580
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1339
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-1339
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
03/20/2018
Last updated
04/25/2018
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