Healthcare Provider Details

I. General information

NPI: 1043469497
Provider Name (Legal Business Name): KARLA BROWN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 W FAIRVIEW AVE STE 120
BOISE ID
83704-8046
US

IV. Provider business mailing address

6855 W FAIRVIEW AVE STE 120
BOISE ID
83704-8046
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-8888
  • Fax: 208-323-8889
Mailing address:
  • Phone: 208-323-8888
  • Fax: 208-323-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-443
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: