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Individual

MS. BRIANA NORA TYNE ACKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
100 HOSPITAL DRIVE, KETCHUM, ID 83340
(208) 727-8100
Mailing address
PO BOX 100, KETCHUM, ID 83340-0100
(208) 727-8800

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2032
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OT-2032
IDAHO OCCUPATIONAL THERAPY LICENSE
ID
Enumeration date
02/13/2019
Last updated
02/13/2019
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