=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386970036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY JANE AKIN O.T.R./L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2009
-----------------------------------------------------
Last Update Date | 10/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 872 TROY RD
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-4046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-892-8888
-----------------------------------------------------
Fax | 208-882-8890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 872 TROY RD
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-4046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-892-8888
-----------------------------------------------------
Fax | 208-882-8890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT458
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------