Individual
IRENE A CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
255 MAGNOLIA AVE, FRUITLAND, ID 83619-5019
(541) 216-3142
Mailing address
255 MAGNOLIA AVE, FRUITLAND, ID 83619-5019
(541) 216-3142
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1937
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020322
OCCUPATIONAL THERAPY LICENSING BOARD
OR
01
—
1020322
NATIONAL BOARD OF CERTIFICATION IN OCCUPATIONAL THERAPY
—
01
—
OT-1937
THE OCCUPATIONAL THERAPY LICENSURE BOARD
ID
Enumeration date
07/30/2018
Last updated
07/30/2018
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