Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
N | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1528400793 |
---|---|
Provider Name | Marilyn Standfield |
First Address | Idaho Falls, ID 83404-7072 |
Second Address | Idaho Falls, ID 83404-7072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 09/08/2013 |