Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1689851776 |
---|---|
Provider Name | Mrs. Deanna Marie Huckabee |
First Address | Boise, ID 83706-3708 |
Second Address | Boise, ID 83706-3708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 30/01/2008 |