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General NPI Number Information
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NPI Number | 1215850672
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Entity Type | Individual
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Provider Name | CARRIE OTTERNESS
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Gender | Female
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 12222 W BRIDGER BAY DR
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City | STAR
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State | ID
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Zip | 83669-5081
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Country | US
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Telephone | 208-391-2773
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Fax |
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Provider Business Mailing Address
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Address Line | 224 ANDERSON ST
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City | CALDWELL
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State | ID
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Zip | 83605-3910
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Country | US
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Telephone | 360-523-8944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5281027
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License Number State | ID
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