Healthcare Provider Details

I. General information

NPI: 1851287163
Provider Name (Legal Business Name): MADELINE REEB OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 E GALA ST STE 100
MERIDIAN ID
83642-5210
US

IV. Provider business mailing address

3137 N NETWORK LN
BOISE ID
83704-6043
US

V. Phone/Fax

Practice location:
  • Phone: 208-955-7333
  • Fax:
Mailing address:
  • Phone: 208-881-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7371268
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: