Individual
AMANDA LAGERSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT OTR/L
Contact information
Practice address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
(208) 529-2255
Mailing address
6070 S 2000 W, REXBURG, ID 83440-4441
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2588
ID
Other
Enumeration date
08/23/2022
Last updated
08/23/2022
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