Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTP-OT-LIC-3253 | MT |
NPI | 1265829220 |
---|---|
Provider Name | Terese Boeder |
First Address | Kalispell, MT 59901-1404 |
Second Address | Kalispell, MT 59901-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 16/04/2015 |