Individual
MICHAEL DAVID BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 489-4444
Mailing address
250 N GARDEN ST, BOISE, ID 83706-1832
(307) 747-6453
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2071
ID
Other
Enumeration date
07/02/2019
Last updated
07/02/2019
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