Healthcare Provider Details

I. General information

NPI: 1689746703
Provider Name (Legal Business Name): KERRI LEWIS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 IRONWOOD PL
COEUR D ALENE ID
83814-2610
US

IV. Provider business mailing address

801 N C ST
COEUR D ALENE ID
83814-2220
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-6486
  • Fax: 208-664-3459
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-812
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT3934
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: