Healthcare Provider Details

I. General information

NPI: 1356027718
Provider Name (Legal Business Name): SAVANNAH LEIGH IPSEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 IRIS DR
SALINAS CA
93906-3514
US

IV. Provider business mailing address

13001 W WOODSPRING ST
BOISE ID
83713-1348
US

V. Phone/Fax

Practice location:
  • Phone: 831-449-1515
  • Fax:
Mailing address:
  • Phone: 208-850-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: