Provider Demographics
NPI:1063546174
Name:TRAMMEL, JOANNE MARIE (OT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:TRAMMEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:ROTHWEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 E CHUBBUCK RD
Mailing Address - Street 2:STE A
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5055
Mailing Address - Country:US
Mailing Address - Phone:208-417-0011
Mailing Address - Fax:888-437-2431
Practice Address - Street 1:265 E CHUBBUCK RD
Practice Address - Street 2:STE A
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5055
Practice Address - Country:US
Practice Address - Phone:208-417-0011
Practice Address - Fax:888-437-2431
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist