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General NPI Number Information
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NPI Number | 1669734042
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Entity Type | Organization
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Legal Business Name | MOSCOW CHARTER SCHOOL
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 1723 E F STREET
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City | MOSCOW
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State | ID
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Zip | 83843-9571
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Country | US
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Telephone | 208-883-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 1723 E F ST
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City | MOSCOW
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State | ID
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Zip | 83843-9571
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SHARON LYNN DUNN
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Credential |
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Telephone | 208-883-3195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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