Healthcare Provider Details

I. General information

NPI: 1134568447
Provider Name (Legal Business Name): JENNIFER HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KRUSE

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 W FRANKLIN RD
BOISE ID
83709-0926
US

IV. Provider business mailing address

1906 FAIRVIEW AVE SUITE 330
CALDWELL ID
83605-5407
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-4200
  • Fax:
Mailing address:
  • Phone: 208-454-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL-1246
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: