Individual
LISA D BOGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1220 MONTANA ST, GOODING, ID 83330-1856
(208) 934-5601
Mailing address
880 E 2700 S, HAGERMAN, ID 83332-5602
(208) 358-1373
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT335
ID
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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