Provider Demographics
NPI:1659615276
Name:GARRISON, ELIZABETH H (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:GARRISON
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 1:10025 N BLACKTAIL AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9567
Mailing Address - Country:US
Mailing Address - Phone:208-761-8180
Mailing Address - Fax:
Practice Address - Street 1:10025 N BLACKTAIL AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-9567
Practice Address - Country:US
Practice Address - Phone:208-761-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist