Journey Pediatric Therapy

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

OT-1405 Issued in ID

Legal business name

JOURNEY PEDIATRIC THERAPY

Practice address

1009 Highway 2 Ste C
Sandpoint, ID 83864-2713

Phone

(208) 627-8615

Fax

(208) 441-2641

NPI assigned

Sep 18, 2015

Last updated

Jun 1, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maresa Black, OTR/LNPI 1750758702

Title

Occupational Therapist and Owner

Phone

(208) 627-8615

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maresa Black, MOT, OTR/L

  • Pediatric Occupational Therapist
  • Sandpoint, ID
  • NPI 1750758702

  Pediatrics

  NPD Authorized official
• Caitlyn Elikh, OTR/L

  • Occupational Therapist
  • Sandpoint, ID
  • NPI 1124587969
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1023487105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2476",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838640914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 HIGHWAY 2 STE C",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838642713",
            "telephone_number": "208-627-8615",
            "fax_number": "208-441-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOURNEY PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "MARESA",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST AND OWNER",
        "authorized_official_telephone_number": "208-627-8615",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "ID",
            "license": "OT-1405",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023487105",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750758702",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Bradley Johnson, D.D.S.
• Jason Jay Jones, LMT
• Jennifer Jones, P.T.
• Toni Jones, LPCP
• Rene L. Jourdan, LCPC
• Jill Shelley Kahn, M.A.
• Christopher Michael Kalinowski, LMT
• Nathan Christian Kanning, M.D.
• Charles E Kees, SLP
• Benjamin Keggi, D.O.

• Rehabilitation Clinic/Center in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Rehabilitation Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.