Kathryn Broderius, MOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-2455 Issued in ID

Practice address

316 E 1St St
Middleton, ID 83644-6159

Phone

(208) 654-6161

NPI assigned

Jan 26, 2022

Last updated

Jan 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Foundations Pediatric Therapy PLLC

  • Pediatric Occupational Therapist
  • Middleton, ID
  • NPI 1295339620

  Pediatrics

  NPD

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1154074508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 E DOWNS AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836861385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 E 1ST ST",
            "city": "MIDDLETON",
            "state": "ID",
            "postal_code": "836446159",
            "telephone_number": "208-654-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERIUS",
        "first_name": "KATHRYN",
        "name_prefix": "Mrs.",
        "credential": "MOT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ID",
            "license": "OT-2455",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-2455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Ballard, LMSW
• Kriste Ann Barnes-Perrin, SLP-CCC
• Brandi Bechtel, LPC
• Jeffrey Bennett
• Cynthia Marie Brice, LMSW
• Amanda Lou Brunmeier
• Canyon County Home Care Inc
• Kristin A Christensen, PA
• Joan Lynn Colombo
• Community Health Clinics, Inc

• Occupational Therapist in Middleton, ID
• Providers in Middleton, ID by specialty
• Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.