Preston Roger Poulter, OTR/L MSOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-2860 Issued in ID

Practice address

564 S Woodruff Ave
Idaho Falls, ID 83401-5298

Phone

(208) 523-7571

Fax

(208) 523-7573

NPI assigned

Mar 28, 2024

Last updated

Apr 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Falls Hand Therapy Limited PartnershipGroup PAC ID 5496002396, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Idaho Falls Hand Therapy Limited Partnership

  • Physical Therapy Clinic/Center
  • Idaho Falls, ID
  • NPI 1134625338

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Clover Caregivers LLC

  • In Home Supportive Care Agency
  • Idaho Falls, ID
  • NPI 1821960469
  NPD Authorized official

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

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1154172245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015298",
            "telephone_number": "208-523-7571",
            "fax_number": "208-523-7573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015298",
            "telephone_number": "208-523-7571",
            "fax_number": "208-523-7573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULTER",
        "first_name": "PRESTON",
        "middle_name": "ROGER",
        "credential": "OTR/L MSOT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-2860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Michael Poston, MD
• Brynn Noel Potere
• Aaron Ryan Potter, PA-C
• Michael Potter
• Alan Jake Poulter, MD
• Brecon Powell, PHARMD
• Carly Kay Powell
• Tara Powell, PA-C
• Powers Counseling, PLLC
• Suzanne Taylor Powers, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.