Provider Demographics
NPI:1134790124
Name:BOISE MUSIC THERAPY COMPANY
Entity type:Organization
Organization Name:BOISE MUSIC THERAPY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MM, MT-BC
Authorized Official - Phone:208-906-3875
Mailing Address - Street 1:2924 N CAPE COD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4440
Mailing Address - Country:US
Mailing Address - Phone:208-906-3875
Mailing Address - Fax:
Practice Address - Street 1:1471 S VINNELL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1659
Practice Address - Country:US
Practice Address - Phone:208-906-3875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities