Individual
STACEY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1009 W QUINN RD, POCATELLO, ID 83202-2425
(208) 427-4155
Mailing address
42 HILLCREST DR, POCATELLO, ID 83204-4729
(208) 427-4155
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1527
ID
Other
Enumeration date
01/19/2018
Last updated
01/19/2018
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