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General NPI Number Information
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NPI Number | 1104613728
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Entity Type | Organization
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Legal Business Name | UNBOUND OT
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 617 E BURDOCK LOOP
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City | HAYDEN
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State | ID
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Zip | 83835-7977
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Country | US
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Telephone | 972-832-8734
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Fax |
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Provider Business Mailing Address
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Address Line | 617 E BURDOCK LOOP
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City | HAYDEN
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State | ID
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Zip | 83835-7977
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Country | US
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Telephone | 972-832-8734
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA WILLSON
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Credential | OTR, OTD, MOT, ATP
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Telephone | 972-832-8734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number |
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License Number State |
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