Individual
VENITA JILL PETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
1033 W QUINN RD, POCATELLO, ID 83202-2425
(208) 233-4800
(208) 233-4886
Mailing address
1033 W QUINN RD, POCATELLO, ID 83202-2425
(208) 233-4800
(208) 233-4886
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-455
ID
Other
Enumeration date
03/30/2011
Last updated
06/21/2011
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