Provider Demographics
NPI:1083780530
Name:VOSS, ANGIE (OT)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:VOSS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 S ROOKERY LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5471
Mailing Address - Country:US
Mailing Address - Phone:208-424-8502
Mailing Address - Fax:
Practice Address - Street 1:3182 S ROOKERY LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5471
Practice Address - Country:US
Practice Address - Phone:208-424-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-430225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDW1224OtherBLUE CROSS OF IDAHO
ID808039400Medicaid