Individual
MRS. LAURA CHRISTINE BRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A/L
Contact information
Practice address
428 E 370 S, DIETRICH, ID 83324-5202
(208) 490-4122
Mailing address
428 E 370 S, DIETRICH, ID 83324-5202
(208) 490-4122
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTA-158
ID
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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