Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT-127 | ID |
NPI | 1396944302 |
---|---|
Provider Name | Ms. Jill Ann Schuette |
First Address | Pocatello, ID 83204-7112 |
Second Address | Pocatello, ID 83204-7112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/08/2018 |