NPIMap

Organization Active NPI

Lullaby Waters PLLC

  • Occupational Therapist
  • Boise, ID
National Provider Identifier
1114342755
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT-1014 Issued in ID
Legal business name
LULLABY WATERS PLLC
Practice address
1410 S Broadway Ave
Boise, ID 83706-3706
Phone
(208) 949-3481
NPI assigned
Feb 19, 2014
Last updated
Jul 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
Nicole Nickell
Title
Owner
Phone
(208) 949-3481

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT-1014 ID Primary

Addresses

Primary practice location

1410 S Broadway Ave
Boise, ID 83706-3706

Mailing address

179 E Old Saybrook Dr
Boise, ID 83706-4918

National Provider Directory

National Provider Directory

Locations

1410 S Broadway Ave
Boise, ID 83706
Phone (208) 433-1410

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1114342755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 E OLD SAYBROOK DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837064918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 S BROADWAY AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063706",
            "telephone_number": "208-949-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LULLABY WATERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-19",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "NICKELL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-949-3481"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-1014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.