Individual
MARISA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
(208) 529-2255
Mailing address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT- 1478
ID
Other
Enumeration date
12/22/2011
Last updated
01/26/2016
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