Provider Demographics
NPI:1083876916
Name:PAGE, MAUREEN ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 N LOOKOUT CIR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9441
Mailing Address - Country:US
Mailing Address - Phone:208-514-7504
Mailing Address - Fax:
Practice Address - Street 1:13121 N LOOKOUT CIR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-9441
Practice Address - Country:US
Practice Address - Phone:208-514-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-709225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics