Provider Demographics
NPI:1285994194
Name:SPANGLER, KAMBER DAWN (MOTR/L)
Entity type:Individual
Prefix:
First Name:KAMBER
Middle Name:DAWN
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:KAMBER
Other - Middle Name:DAWN
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8364 W BANJO DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6482
Mailing Address - Country:US
Mailing Address - Phone:208-240-4454
Mailing Address - Fax:
Practice Address - Street 1:7211 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0926
Practice Address - Country:US
Practice Address - Phone:208-375-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTL-1134225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist