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General NPI Number Information
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NPI Number | 1215887864
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Entity Type | Organization
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Legal Business Name | STILL WATERS OCCUPATIONAL THERAPY, PLLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 424 E SHERMAN AVE STE 307
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2756
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Country | US
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Telephone | 951-255-9034
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Fax |
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Provider Business Mailing Address
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Address Line | 424 E SHERMAN AVE STE 307
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2756
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Country | US
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Telephone | 951-255-9034
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | JESSICA HAN
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Credential |
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Telephone | 951-255-9034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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