MEDICARE: JANICE KYTLE SEARGENT MED OTR/L-ATP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225CA2400X	Assistive Technology Practitioner Rehabilitation Counselor	OT009	ID
2	225400000X	Rehabilitation Practitioner	OT009	ID
3	225XH1200X	Hand Occupational Therapist	OT009	ID
4	225XP0200X	Pediatric Occupational Therapist	OT009	ID

General Provider Information

NPI Number	:	1447343462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE KYTLE SEARGENT MED OTR/L-ATP

Provider Business Mailing Address
First Line	:	1820 E 17TH STREET
Second Line	:	SUITE 120
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6472
Country	:	US
Telephone Number	:	208-529-3358
Fax Number	:	208-529-3382

Provider Business Practice Location Address
First Line	:	1820 E 17TH STREET
Second Line	:	SUITE 120
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6472
Country	:	US
Telephone Number	:	208-529-3358
Fax Number	:	208-529-3382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/11/2012

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