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NPI Code Detail

MEDICARE: MS. LYNNE KAREN WETTERLIN OT

MEDICARE: MS. LYNNE KAREN WETTERLIN OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT-061ID

General Provider Information

NPI Number : 1285896027
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LYNNE KAREN WETTERLIN OT
Provider Business Mailing Address
First Line : 820 ELM ST
Second Line :
City : SAINT MARIES
State : ID
Zip : 83861-2119
Country : US
Telephone Number : 208-245-4576
Fax Number : 208-245-2138
Provider Business Practice Location Address
First Line : 820 ELM ST
Second Line :
City : SAINT MARIES
State : ID
Zip : 83861-2119
Country : US
Telephone Number : 208-245-4576
Fax Number : 208-245-2138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2008
Last Update Date : 07/01/2008

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