AMANDA BLACK

POTLATCH, ID
NPI1992362818
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy225X00000X Occupational Therapist
(Licence: ID  OT-1112)
Additional Taxonomies225XP0200X Occupational Therapist, Pediatrics
(Licence: ID  OT-1112)
Enumeration Date2019-05-27
Last Update Date2022-04-08
Business Address
AMANDA BLACK MOT, OTR/L
510 ELM ST
POTLATCH, ID 83855
Phone number: 208-669-3186
Mailing Address
AMANDA BLACK MOT, OTR/L
1026 GRANGE PARK RD
PRINCETON, ID 83857-5500
Phone number: 208-669-3186
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