Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 12159 | CA |
Y | 225X00000X | Occupational Therapist | 1650 | ID |
NPI | 1003360421 |
---|---|
Provider Name | Lauren Armstrong |
First Address | Boise, ID 83702-3052 |
Second Address | Nampa, ID 83651-5074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2016 |
Last Update Date | 15/08/2016 |