Individual
ELIZABETH KIRSTEN WITZKE
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
(612) 810-7448
Mailing address
13905 JAMES AVE S, BURNSVILLE, MN 55337-4435
(612) 810-7448
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1692
ID
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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