Healthcare Provider Details

I. General information

NPI: 1073663522
Provider Name (Legal Business Name): ELIZABETH A DURAN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH GONDER

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 N MOLTER RD STE 101
LIBERTY LAKE WA
99019-7570
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 509-324-1222
  • Fax: 509-324-1223
Mailing address:
  • Phone: 208-262-2498
  • Fax: 208-262-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number8481105
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00004425
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: