TINA WAYLAND FULLER, COTA/L

Occupational Therapy Assistant

Active Individual
NPI: 1922420736

Practice Address

895 N 6TH E
Mt Home, ID 83647

Phone: (208) 580-9806

Specialties

Specialty Code Primary License
Occupational Therapy Assistant 224Z00000X Yes OTA-1095 (ID)

Frequently Asked Questions

NPI 1922420736 is the National Provider Identifier for TINA WAYLAND FULLER, COTA/L, a Occupational Therapy Assistant provider located in Mt Home, ID. This NPI was enumerated on January 13, 2014.
TINA WAYLAND FULLER, COTA/L practices at 895 N 6TH E, Mt Home, ID 83647.

Quick Facts

NPI
1922420736
Type
Individual
Enumerated
Jan 13, 2014
Last Updated
Jan 13, 2014

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