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General NPI Number Information
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NPI Number | 1689082182
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Entity Type | Organization
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Legal Business Name | GENERATIONS OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 3715 WOODKING DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4720
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Country | US
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Telephone | 208-521-3253
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Fax | 208-529-2022
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Provider Business Mailing Address
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Address Line | 694 MELROSE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3250
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Country | US
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Telephone | 208-521-3253
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Fax | 208-529-2022
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA K HONG
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Credential | MOTR/L
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Telephone | 208-521-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OT-849
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License Number State | ID
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