Individual
ELISA BOVENZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
101 S ALLUMBAUGH WAY, BOISE, ID 83709-5658
(208) 323-8888
(208) 323-8889
Mailing address
101 S ALLUMBAUGH WAY, BOISE, ID 83709-5658
(208) 323-8888
(208) 323-8889
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT-446
ID
225XP0200X
Pediatric Occupational Therapist
Primary
OT-446
ID
Other
Enumeration date
11/13/2008
Last updated
10/05/2022
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