Provider Demographics
NPI:1720308588
Name:ALDRICH, DEBBIE JOY (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:JOY
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E PLAZA ST
Mailing Address - Street 2:B # 157
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5981
Mailing Address - Country:US
Mailing Address - Phone:208-407-2801
Mailing Address - Fax:
Practice Address - Street 1:228 E PLAZA ST
Practice Address - Street 2:B # 157
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5981
Practice Address - Country:US
Practice Address - Phone:208-407-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA 156224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant