Individual
MS. PATRICIA ANN PROVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
600 N CECIL RD, POST FALLS, ID 83854-6200
(208) 262-2800
Mailing address
1301 N B ST, COEUR D ALENE, ID 83814-2319
(509) 714-8460
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
60224627
WA
225X00000X
Occupational Therapist
Primary
OT-712
ID
Other
Enumeration date
07/03/2007
Last updated
08/26/2019
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