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General NPI Number Information
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NPI Number | 1679493258
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Entity Type | Individual
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Provider Name | DIVA MARINE LAMOTTE
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 5255 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83705-2637
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Country | US
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Telephone | 208-338-9486
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Fax |
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Provider Business Mailing Address
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Address Line | 2102 S ROOSEVELT ST
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City | BOISE
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State | ID
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Zip | 83705-3262
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Country | US
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Telephone | 208-703-5644
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT-4622
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License Number State | ID
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