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General NPI Number Information
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NPI Number | 1982922043
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Entity Type | Organization
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Legal Business Name | PRACTICE PARTNERS, LLC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 4185 BIRCHWOOD CIR
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City | AMMON
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State | ID
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Zip | 83406-4648
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Country | US
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Telephone | 208-528-8599
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Fax |
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Provider Business Mailing Address
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Address Line | 4185 BIRCHWOOD CIR
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City | AMMON
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State | ID
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Zip | 83406-4648
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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 | PRESIDENT
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Name | MRS. TOMI NICHOLE SMITH
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Credential |
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Telephone | 208-528-8599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT-965
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License Number State | ID
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