Healthcare Provider Details

I. General information

NPI: 1306767934
Provider Name (Legal Business Name): RIETA ANN ELDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 S MILLENIUM WAY # 120
MERIDIAN ID
83642-1510
US

IV. Provider business mailing address

12479 MOSS LN
NAMPA ID
83651-8106
US

V. Phone/Fax

Practice location:
  • Phone: 208-600-0722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2081228
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: