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NPI Code Detail

MEDICARE: AMANDA JEAN CRAIG OTR/L

MEDICARE: AMANDA JEAN CRAIG OTR/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
1225X00000XOccupational TherapistOT-1345ID

General Provider Information

NPI Number : 1710393004
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JEAN CRAIG OTR/L
Provider Business Mailing Address
First Line : 4706 W CORPORAL ST
Second Line :
City : BOISE
State : ID
Zip : 83706-1925
Country : US
Telephone Number : 208-949-0755
Fax Number :
Provider Business Practice Location Address
First Line : 4706 W CORPORAL ST
Second Line :
City : BOISE
State : ID
Zip : 83706-1925
Country : US
Telephone Number : 208-949-0755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2014
Last Update Date : 07/08/2014

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