Provider Demographics
NPI:1275788309
Name:CROSSER, ANNE MARIE (OT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:CROSSER
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 1:3410 E PHEASANT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4788
Mailing Address - Country:US
Mailing Address - Phone:505-681-9415
Mailing Address - Fax:
Practice Address - Street 1:444 HOSPITAL WAY STE 720
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-478-0258
Practice Address - Fax:208-269-7336
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist