NPI 1588704118

Tara Anne Kishpaugh, LATATC

Practitioner Athletic Trainer Eagle, ID

Practice location

Address: 574 Park Ln, Eagle, ID 83616-4512
Phone: (208) 939-2189
Mailing address: 1229 Fleetwood Ln, Boise, ID 83706-4541

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT-280 (ID)

Other Specialist/Technologist providers in Idaho →

Registry record

NPI: 1588704118
Entity type: Individual
Sex (as registered): Female
NPI issued: 6 Feb 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.