Provider Demographics
NPI:1063672384
Name:OFTEDAL, SARAH ANN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:OFTEDAL
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 S ADONIS PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6951
Mailing Address - Country:US
Mailing Address - Phone:208-794-2674
Mailing Address - Fax:
Practice Address - Street 1:5609 S ADONIS PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6951
Practice Address - Country:US
Practice Address - Phone:208-794-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist