Provider Demographics
NPI:1437204922
Name:DEANGELIS, CAREN (MA OTRL CHT)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:MA OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IDAHO HAND CENTER
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1338
Mailing Address - Country:US
Mailing Address - Phone:208-342-4262
Mailing Address - Fax:208-375-0597
Practice Address - Street 1:IDAHO HAND CENTER
Practice Address - Street 2:SUITE 304
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1338
Practice Address - Country:US
Practice Address - Phone:208-342-4262
Practice Address - Fax:208-375-0597
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-824225XE1200X, 225XH1200X
CA176225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics