MEDICARE: SARAH ANN OFTEDAL MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT-648	ID

General Provider Information

NPI Number	:	1063672384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANN OFTEDAL MOTR/L

Provider Business Mailing Address
First Line	:	5609 S ADONIS PL
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83716-6951
Country	:	US
Telephone Number	:	208-794-2674
Fax Number	:

Provider Business Practice Location Address
First Line	:	5609 S ADONIS PL
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83716-6951
Country	:	US
Telephone Number	:	208-794-2674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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Directions to “ SARAH ANN OFTEDAL MOTR/L” Practice Location

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