Individual
KRISTI LYN BOOTH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
415 E PARKCENTER BLVD, SUITE 114, BOISE, ID 83706-6504
(208) 433-9211
(208) 433-9241
Mailing address
11481 SW HALL BLVD, SUITE 201, PORTLAND, OR 97223-8403
(800) 219-8835
(503) 443-1402
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
1013068
OR
235Z00000X
Speech-Language Pathologist
OT00002780
WA
235Z00000X
Speech-Language Pathologist
Primary
OT495
ID
Other
Enumeration date
12/02/2005
Last updated
07/08/2007
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