Healthcare Provider Details

I. General information

NPI: 1710960463
Provider Name (Legal Business Name): CDA HAND THERAPY & HEALING CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 MERRITT CREEK LOOP SUITE 2A
COEUR D ALENE ID
83814-4953
US

IV. Provider business mailing address

2448 MERRITT CREEK LOOP SUITE 2A
COEUR D ALENE ID
83814-4953
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-2901
  • Fax: 208-667-9266
Mailing address:
  • Phone: 208-664-2901
  • Fax: 208-667-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. VIRGINIA TAFT
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 208-664-2901