Healthcare Provider Details

I. General information

NPI: 1548977648
Provider Name (Legal Business Name): OMNI KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MADRONA ST N # 1000
TWIN FALLS ID
83301-8318
US

IV. Provider business mailing address

1579 CREEK STONE CIR
TWIN FALLS ID
83301-5887
US

V. Phone/Fax

Practice location:
  • Phone: 208-705-2338
  • Fax:
Mailing address:
  • Phone: 208-705-2338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KYLIE HOHWIELER
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 208-705-2338