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General NPI Number Information
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NPI Number | 1013184837
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Entity Type | Individual
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Provider Name | MARYANNE KLEVEN OTRL
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Gender | Female
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 500 W AQUA AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83815-7764
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Country | US
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Telephone | 208-762-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 W BORDON CT
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City | RATHDRUM
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State | ID
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Zip | 83858-6496
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Country | US
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Telephone | 208-651-5505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT-731
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License Number State | ID
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