Healthcare Provider Details

I. General information

NPI: 1568347060
Provider Name (Legal Business Name): ERIN RAE O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S FITNESS PL
EAGLE ID
83616-6828
US

IV. Provider business mailing address

16899 N CORNWALLIS WAY
NAMPA ID
83687-8257
US

V. Phone/Fax

Practice location:
  • Phone: 208-957-6301
  • Fax: 208-228-0585
Mailing address:
  • Phone: 856-628-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8171475
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: