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General NPI Number Information
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NPI Number | 1487240834
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Entity Type | Organization
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Legal Business Name | DESTINATION OCCUPATIONAL THERAPY PLLC
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 3583 N MCMULLEN DR
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City | POST FALLS
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State | ID
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Zip | 83854-0050
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Country | US
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Telephone | 509-481-8694
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Fax |
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Provider Business Mailing Address
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Address Line | 3583 N MCMULLEN DR
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City | POST FALLS
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State | ID
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Zip | 83854-0050
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Country | US
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Telephone | 509-481-8694
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL EDWARD WILLIAMS
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Credential | MOTR/L
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Telephone | 509-481-8694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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