Individual
CLAIRE E MALLICOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(865) 223-2172
Mailing address
7642 BORUFF RD, CORRYTON, TN 37721-3302
(865) 223-2172
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2743
ID
Other
Enumeration date
05/24/2023
Last updated
05/24/2023
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