Individual
MARY LOUISE ELMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2814 S INDIANA AVE, CALDWELL, ID 83605-5925
(208) 454-0380
(208) 454-6388
Mailing address
6330 TAHOE DR, BOISE, ID 83709-1067
(208) 841-9243
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-134
ID
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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