Organization
PRACTICE PARTNERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TOMI NICHOLE SMITH (PRESIDENT)
(208) 528-8599
Entity
Organization
Contact information
Practice address
4185 BIRCHWOOD CIR, AMMON, ID 83406-4648
(208) 528-8599
Mailing address
4185 BIRCHWOOD CIR, AMMON, ID 83406-4648
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT-965
ID
Other
Enumeration date
05/12/2010
Last updated
05/12/2010
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