Healthcare Provider Details

I. General information

NPI: 1669007852
Provider Name (Legal Business Name): MICHAELA JOY AINSLEY MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 E JARVIS ST
MERIDIAN ID
83642-2681
US

IV. Provider business mailing address

443 E JARVIS ST
MERIDIAN ID
83642-2681
US

V. Phone/Fax

Practice location:
  • Phone: 208-582-5925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2171
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: