MEDICARE: MR. JAMES ALBERT KING MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT00003463	WA
2	225XP0200X	Pediatric Occupational Therapist	OT-843	ID

General Provider Information

NPI Number	:	1538355532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ALBERT KING MS, OTR/L

Provider Business Mailing Address
First Line	:	4846 WIND RIVER RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-5828
Country	:	US
Telephone Number	:	208-339-4300
Fax Number	:	208-552-0395

Provider Business Practice Location Address
First Line	:	4846 WIND RIVER RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-5828
Country	:	US
Telephone Number	:	208-339-7234
Fax Number	:	208-552-0395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	07/03/2012

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