Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT-1712 | ID |
NPI | 1083141345 |
---|---|
Provider Name | Shelby Rae Lunday |
First Address | Meridian, ID 83642-8220 |
Second Address | Mountain Home, ID 83647-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |