Individual
ELYSE MARIE POWDERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-1000
Mailing address
214 TARA WOODS DR APT 2, BUMPASS, VA 23024-4935
(732) 861-2193
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2636
ID
Other
Enumeration date
09/19/2022
Last updated
09/19/2022
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