Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | OT-242 | ID |
Y | 225X00000X | Occupational Therapist | OT-242 | ID |
NPI | 1114081569 |
---|---|
Provider Name | Lesley Ruby |
First Address | Filer, ID 83328-5549 |
Second Address | Buhl, ID 83316-1627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 16/07/2014 |