Healthcare Provider Details

I. General information

NPI: 1659029353
Provider Name (Legal Business Name): OT 4 KIDZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S. FITNESS PL.
EAGLE ID
83616
US

IV. Provider business mailing address

449 S. FITNESS PL.
EAGLE ID
83616
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 TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

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