Organization
CAMP HIPPO PEDIATRIC THERAPY LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTY C. JAQUES OTR/L (OCCUPATIONAL THERAPIST/OWNER)
(208) 782-2267
Entity
Organization
Contact information
Practice address
7 N 600 W, BLACKFOOT, ID 83221-5533
(208) 782-2267
(208) 684-9812
Mailing address
7 N 600 W, BLACKFOOT, ID 83221-5533
(208) 782-2267
(208) 684-9812
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
OT-232
ID
261QM2500X
Medical Specialty Clinic/Center
OT-232
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232-OT
OT LICENSE
ID
Enumeration date
02/01/2008
Last updated
02/01/2008
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