Amanda Lagerstrom, MOT OTR/L
Individual provider Active NPI Occupational Therapist · Idaho Falls, ID
NPI 1134848286 · NPPES record last updated Aug 23, 2022
Key facts
- NPI
- 1134848286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT-2588 (ID)
- Practice address
- 3715 Woodking Dr
Idaho Falls, ID 83404-4720 - Phone
- (208) 529-2255
- NPI assigned
- Aug 23, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221017001964 | ID | Practitioner - Occupational Therapist in Private Practice | 6608242623 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Achieve Therapy and Learning Services, LLC | Occupational Therapist | Current |
Accepting new patients |
| Bounce Back OT LLC | Occupational Therapist | Current |
Accepting new patients |
| Foothills Rehabilitation & Performance Services, PLLC | Occupational Therapist | Current |
Accepting new patients |
Locations
3715 Woodking Dr
Idaho Falls, ID 83404
Phone (208) 529-2255
586 1st St
Idaho Falls, ID 83401
Phone (208) 523-6988
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT-2588 | ID | Yes |
Addresses
Primary practice location
3715 Woodking Dr
Idaho Falls, ID 83404-4720
Mailing address
6070 S 2000 W
Rexburg, ID 83440-4441
Other providers in Idaho Falls, ID
- Kylin Kovac DPM PLLC
- Itzel Labra
- Yeimi Labra
- Darrick Taylor Lacey
- Elizabeth Rae Lagazo
- Abish Shu-Yi Lai
- Justin A Lamb
- Bradley Kent Lambson
- Malory Ruth Lambson
- Trina Lambson
All providers in Idaho Falls, ID · Occupational Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.