Provider Demographics
NPI:1407634207
Name:WEINGART, AMBER (OT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WEINGART
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 1:13028 S HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:CATALDO
Mailing Address - State:ID
Mailing Address - Zip Code:83810-9691
Mailing Address - Country:US
Mailing Address - Phone:208-964-2301
Mailing Address - Fax:
Practice Address - Street 1:102 W 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9255
Practice Address - Country:US
Practice Address - Phone:208-981-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2782225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist