Provider Demographics
NPI:1689015174
Name:SPECK, PATRICIA M (OTR/L)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:SPECK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 E FRANKLIN RD, STE 303
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2376
Mailing Address - Country:US
Mailing Address - Phone:208-939-3334
Mailing Address - Fax:208-939-1122
Practice Address - Street 1:3071 E FRANKLIN RD, STE 303
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2376
Practice Address - Country:US
Practice Address - Phone:208-939-3334
Practice Address - Fax:208-939-1122
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1247225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist