Healthcare Provider Details

I. General information

NPI: 1104613728
Provider Name (Legal Business Name): UNBOUND OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E BURDOCK LOOP
HAYDEN ID
83835-7977
US

IV. Provider business mailing address

617 E BURDOCK LOOP
HAYDEN ID
83835-7977
US

V. Phone/Fax

Practice location:
  • Phone: 972-832-8734
  • Fax:
Mailing address:
  • Phone: 972-832-8734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA MARKES WILLSON
Title or Position: OWNER
Credential: OTR/L, OTD, MOT, ATP
Phone: 972-832-8734