Individual
MR. NICHOLAS RAY RIVELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
449 S FITNESS PL, EAGLE, ID 83616-6828
(208) 957-6301
Mailing address
7458 W SAXTON DR APT 202, BOISE, ID 83714-1320
(701) 330-8842
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2273
ID
Other
Enumeration date
09/16/2020
Last updated
09/16/2020
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