=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699087346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IDAHO HAND & UPPER EXTREMITY THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2010
-----------------------------------------------------
Last Update Date | 01/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 W IRONWOOD DR STE 207
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-651-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3482
-----------------------------------------------------
City | POST FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83877-3482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-651-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT SWIDER
-----------------------------------------------------
Credential | OTR/L, CHT
-----------------------------------------------------
Telephone | 208-651-4551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | OT-705
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------