Individual
JESSICA OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 ROWE ST, MOSCOW, ID 83843-9319
(208) 882-4576
Mailing address
420 ROWE ST, MOSCOW, ID 83843-9319
(208) 882-4576
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-208
ID
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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