Individual
MATTHEW ALAN HENSLEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1130 ALLUMBAUGH ST, BOISE, ID 83704-8700
(208) 854-8517
Mailing address
340 STIERMAN WAY, EAGLE, ID 83616-5166
(208) 340-4929
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
OTA185
ID
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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