Provider Demographics
NPI:1558880914
Name:KAHRE, HAILEY LUCILE
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:LUCILE
Last Name:KAHRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:LUCILE
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5460 EL PASO RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-7417
Mailing Address - Country:US
Mailing Address - Phone:208-697-2705
Mailing Address - Fax:
Practice Address - Street 1:501 W IDAHO BLVD
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9694
Practice Address - Country:US
Practice Address - Phone:208-365-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1504224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant