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General NPI Number Information
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NPI Number | 1902773799
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Entity Type | Organization
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Legal Business Name | FAR NORTH PEDIATRICS
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 2290 N CENTER VALLEY RD
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City | SANDPOINT
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State | ID
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Zip | 83864-8684
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Country | US
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Telephone | 505-269-2325
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Fax | 208-441-2641
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Provider Business Mailing Address
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Address Line | 2290 N CENTER VALLEY RD
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City | SANDPOINT
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State | ID
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Zip | 83864-8684
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Country | US
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Telephone | 505-269-2325
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Fax | 208-441-2641
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | PENNIE L MATHIAS
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Credential | MS, OTR/L
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Telephone | 505-269-2325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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