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Individual

MR. MARK RICHARD SHALTRY

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
OTR CHT

Contact information

Practice address
554 N STEELHEAD WAY, STE 162, BOISE, ID 83704
(208) 323-9747
(208) 323-9752
Mailing address
170 E STONEWATER CT, EAGLE, ID 83706
(208) 323-9747
(208) 323-9752

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT042
ID
225XH1200X
Hand Occupational Therapist
Primary
OT042
ID

Other

Enumeration date
02/22/2006
Last updated
09/11/2025
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