Individual
MRS. JACLYN ANN CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3600 COUNTRY CLUB DR, LEWISTON, ID 83501-9621
(208) 503-2194
Mailing address
3600 COUNTRY CLUB DR, LEWISTON, ID 83501-9621
(208) 503-2194
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
00004442
WA
225X00000X
Occupational Therapist
Primary
OT-768
ID
Other
Enumeration date
06/27/2008
Last updated
04/23/2017
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