Provider Demographics
NPI:1336347178
Name:WEITEMIER, GRETCHEN (MOT, OTRL)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:WEITEMIER
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8026
Mailing Address - Country:US
Mailing Address - Phone:503-250-4111
Mailing Address - Fax:
Practice Address - Street 1:1305 WARM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8026
Practice Address - Country:US
Practice Address - Phone:503-250-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist