Individual
MRS. AMBER IRENE DYSART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-1117
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-1117
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1310
ID
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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