Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
TINA RENEE WAYLAND FULLER, COTA/L
ActiveTINA RENEE WAYLAND FULLER, COTA/L is a Occupational Therapy Assistant healthcare provider located in MT HOME, Idaho. NPI 1922420736 is currently active in the NPPES registry. Verify at CMS.
Occupational Therapy Assistant · MT HOME, ID
Registration Details
- NPI Number
- 1922420736
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jan 13, 2014 (12.586205517834 yrs)
- Last Updated
- Jan 13, 2014
- License
-
OTA-1095 (ID)
Practice Information
- Address
-
895 N 6TH EMT HOME, ID, 836472207Browse ID providers · Browse ZIP 83647
- Phone
- 2085809806
- Primary Specialty
-
Occupational Therapy Assistant
224Z00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.