Healthcare Provider Details

I. General information

NPI: 1962339804
Provider Name (Legal Business Name): CALEB NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 W 5TH AVE STE 101
POST FALLS ID
83854-8746
US

IV. Provider business mailing address

1720 W GARDNER AVE
SPOKANE WA
99201-1833
US

V. Phone/Fax

Practice location:
  • Phone: 208-981-1111
  • Fax:
Mailing address:
  • Phone: 208-981-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number550507
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: