Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2252 | ID |
NPI | 1073126579 |
---|---|
Provider Name | Ms. Taylor Raschke |
First Address | Pocatello, ID 83201-4152 |
Second Address | Pocatello, ID 83201-4132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2020 |
Last Update Date | 25/08/2020 |