IndividualActive
Amanda Black, MOT, OTR/L
NPI 1992362818 · Occupational Therapist · Potlatch, ID
Provider details
- NPI number
- 1992362818
- Entity type
- Individual
- Primary specialty
- Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- MOT, OTR/L
- Sex
- Female
- Sole proprietor
- Yes
- License
- OT-1112 (ID)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
510 Elm St
Potlatch, ID 83855
Phone: (208) 669-3186
Fax: (208) 747-0782
Approximate (ZIP-level) locationGet directions
Mailing address
1026 Grange Park Rd
Princeton, ID 83857-5500
Additional practice locations (1)
- 904 White AveMoscow, ID 83843-3932Phone: (208) 882-1426
Registry dates
- Enumerated
- 2019-05-27
- Last updated
- 2022-04-08
- Certified
- 2022-04-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.