Provider Demographics
NPI:1013392802
Name:BOYLE, HEIDI MAXINE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MAXINE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MAXINE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:3715 WOODKING DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4720
Mailing Address - Country:US
Mailing Address - Phone:208-529-2255
Mailing Address - Fax:
Practice Address - Street 1:3715 WOODKING DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4720
Practice Address - Country:US
Practice Address - Phone:208-529-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist