Provider Demographics
NPI:1790306751
Name:LAYTON, NOVA ORION
Entity Type:Individual
Prefix:
First Name:NOVA
Middle Name:ORION
Last Name:LAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:LACLEDE
Mailing Address - State:ID
Mailing Address - Zip Code:83841-0160
Mailing Address - Country:US
Mailing Address - Phone:208-304-2090
Mailing Address - Fax:
Practice Address - Street 1:1315 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2724
Practice Address - Country:US
Practice Address - Phone:208-263-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist