Individual
MISS KELLY KATHLEEN OTOOLE WOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, LDN
Contact information
Practice address
6126 W STATE ST, BOISE, ID 83703-2741
(208) 407-8921
(208) 694-7837
Mailing address
13447 N 2ND AVE, BOISE, ID 83714-9409
(208) 407-8921
(208) 694-7837
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-460
ID
Other
Enumeration date
03/12/2018
Last updated
11/28/2023
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