Organization
BOISE OUTDOOR OT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANIELE FALLON MA (OCCUPATIONAL THERAPIST)
(208) 918-2657
Entity
Organization
Contact information
Practice address
522 E 40TH ST, GARDEN CITY, ID 83714-6358
(323) 640-2305
Mailing address
522 E 40TH ST, GARDEN CITY, ID 83714-6358
(323) 640-2305
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
08/19/2021
Last updated
11/15/2021
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