Provider Demographics
NPI:1841532496
Name:HARTLEY, NATHAN A (MOTR/L)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 PARTRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4944
Mailing Address - Country:US
Mailing Address - Phone:208-819-9362
Mailing Address - Fax:
Practice Address - Street 1:2422 PARTRIDGE LOOP
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4944
Practice Address - Country:US
Practice Address - Phone:208-819-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist