Individual
ANA DESIRAE RIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
1071 RENEE AVE, POCATELLO, ID 83201-2508
(208) 233-1441
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
(503) 570-3665
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1081
ID
Other
Enumeration date
09/23/2011
Last updated
09/23/2011
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