=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083574768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMAZIA ROSE ESPINOSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 182
-----------------------------------------------------
City | KIMBERLY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83341-0182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-904-3500
-----------------------------------------------------
Fax | 208-904-3547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 182
-----------------------------------------------------
City | KIMBERLY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83341-0182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-904-3500
-----------------------------------------------------
Fax | 208-904-3547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 2171274
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------