Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT-1228 | ID |
NPI | 1003256256 |
---|---|
Provider Name | Dillon Rhet Merrill |
First Address | Saint Anthony, ID 83445-5303 |
Second Address | Rexburg, ID 83440-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2013 |
Last Update Date | 28/03/2014 |