Individual
KELSEY RAYMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2078
(208) 381-2178
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2078
(208) 381-2178
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2114
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223771
HOSPITAL
—
Enumeration date
10/02/2019
Last updated
10/02/2019
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