Healthcare Provider Details

I. General information

NPI: 1457089310
Provider Name (Legal Business Name): CURTIS BRENT PEARSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 E JENALAN
POST FALLS ID
83854-7787
US

IV. Provider business mailing address

145 S BENTLEY PL
POST FALLS ID
83854-9540
US

V. Phone/Fax

Practice location:
  • Phone: 208-262-8700
  • Fax:
Mailing address:
  • Phone: 801-380-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-1439
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT-1439
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: