Individual
LINDA M. HENRIKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA L
Contact information
Practice address
1130 ALLUMBAUGH ST, BOISE, ID 83704-8700
(208) 854-8517
Mailing address
6122 GLENCREST AVE, BOISE, ID 83714-6103
(208) 853-7788
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTA082
ID
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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