Individual
CARRIE OTTERNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12222 W BRIDGER BAY DR, STAR, ID 83669-5081
(208) 391-2773
Mailing address
224 ANDERSON ST, CALDWELL, ID 83605-3910
(360) 523-8944
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5281027
ID
Other
Enumeration date
08/03/2026
Last updated
08/03/2026
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