Individual
WKL EDGERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
449 S FITNESS PL, EAGLE, ID 83616-6828
(208) 957-6301
(208) 228-0585
Mailing address
449 S FITNESS PL, EAGLE, ID 83616-6828
(208) 957-6301
(208) 228-0585
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1121
ID
Other
Enumeration date
02/05/2016
Last updated
02/05/2016
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