Healthcare Provider Details

I. General information

NPI: 1265348403
Provider Name (Legal Business Name): JAXSON JEFFREY BURGEMEISTER OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ADDISON AVE E STE D
TWIN FALLS ID
83301-6748
US

IV. Provider business mailing address

2550 ADDISON AVE E STE D
TWIN FALLS ID
83301-6748
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-8000
  • Fax:
Mailing address:
  • Phone: 208-814-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number9781724
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: