Basic Information
| Provider Information | |||||||||
| NPI: | 1932451002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMRIELL | ||||||||
| FirstName: | BRITTNEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LETE | ||||||||
| OtherFirstName: | BRITTNEY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4650 HAWTHORNE RD | ||||||||
| Address2: | STE 3B | ||||||||
| City: | CHUBBUCK | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832022376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082379833 | ||||||||
| FaxNumber: | 2082371800 | ||||||||
| Practice Location | |||||||||
| Address1: | 4650 HAWTHORNE RD | ||||||||
| Address2: | STE 3B | ||||||||
| City: | CHUBBUCK | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832022376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082379833 | ||||||||
| FaxNumber: | 2082371800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2012 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT-1172 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.