Provider Demographics
NPI:1053033076
Name:SHAVER, AMY LYNN FUST (BS, OTD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN FUST
Last Name:SHAVER
Suffix:
Gender:F
Credentials:BS, OTD
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:FUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1675 W COVENANT HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7098
Mailing Address - Country:US
Mailing Address - Phone:925-683-7294
Mailing Address - Fax:
Practice Address - Street 1:449 S FITNESS PL
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6828
Practice Address - Country:US
Practice Address - Phone:208-957-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist