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General NPI Number Information
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NPI Number | 1881931319
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Entity Type | Organization
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Legal Business Name | OCCUPATIONAL THERAPY UNLIMITED, LLC
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 30 E LITTLE AVE
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City | DRIGGS
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State | ID
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Zip | 83422-5138
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Country | US
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Telephone | 208-709-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 S BONITO WAY STE 190
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City | MERIDIAN
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State | ID
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Zip | 83642-5618
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Country | US
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Telephone | 208-287-9420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMANDA CHEYENNE ENRICO
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Credential | MOTR/L
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Telephone | 208-709-2911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-835
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License Number State | ID
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