Healthcare Provider Details

I. General information

NPI: 1225449085
Provider Name (Legal Business Name): OT 4 KIDZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S FITNESS PL
EAGLE ID
83616-6828
US

IV. Provider business mailing address

449 S FITNESS PL
EAGLE ID
83616-6828
US

V. Phone/Fax

Practice location:
  • Phone: 208-957-6301
  • Fax: 208-228-0585
Mailing address:
  • Phone: 208-957-6301
  • Fax: 208-228-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-897
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KARI THOMPSON
Title or Position: OWNER, DIRECTOR
Credential: OTD, OTR/L
Phone: 208-957-6301