Individual
LISA DENMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
500 W FORT ST, BOISE, ID 83702-4501
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-129
ID
Other
Enumeration date
08/03/2015
Last updated
08/03/2015
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