Individual
GINA M CROCKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1001 S HILTON ST, BOISE, ID 83705-1925
(208) 345-4464
Mailing address
1001 SOUTH HILTON STREET, BOISE, ID 83705
(208) 345-4464
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006
ID
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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