Kathryn Broderius, MOT
Individual provider Active NPI Occupational Therapist · Middleton, ID
NPI 1154074508 · NPPES record last updated Jan 26, 2022
Key facts
- NPI
- 1154074508
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT-2455 (ID)
- Practice address
- 316 E 1St St
Middleton, ID 83644-6159 - Phone
- (208) 654-6161
- NPI assigned
- Jan 26, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-2455 | ID | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Foundations Pediatric Therapy PLLC | Pediatrics | Current |
Accepting new patients |
Locations
412 S King Ave
Ste 103
Middleton, ID 83644
Phone (208) 654-6161
316 E 1st St
Middleton, ID 83644
Phone (208) 473-0115
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT-2455 | ID | |
| Occupational Therapist | 225X00000X | OT-2455 | ID | Yes |
Addresses
Primary practice location
316 E 1St St
Middleton, ID 83644-6159
Mailing address
3700 E Downs Ave
Nampa, ID 83686-1385
Other providers in Middleton, ID
- Jacob Ballard
- Kriste Ann Barnes-Perrin
- Brandi Bechtel
- Jeffrey Bennett
- Cynthia Marie Brice
- Amanda Lou Brunmeier
- Canyon County Home Care Inc
- Kristin A Christensen
- Joan Lynn Colombo
- Community Health Clinics, Inc
All providers in Middleton, 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 Jan 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.