Active NPI
Tyler Hansen, OTR
- Occupational Therapist
- Twin Falls, ID
National Provider Identifier
1164958906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTL- 1765
- Practice address
- 2550 Addison Ave E Ste D
Twin Falls, ID 83301-6749 - Phone
- (208) 814-7700
- NPI assigned
- May 11, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTL- 1765 | ID | Primary |
Addresses
Primary practice location
2550 Addison Ave E Ste D
Twin Falls, ID 83301-6749
Mailing address
511 Magnolia Ave
Twin Falls, ID 83301-6210
Phone (208) 490-0035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTL- 1765 | ID | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518393600000",
"number": "1164958906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 MAGNOLIA AVE",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833016210",
"telephone_number": "208-490-0035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 ADDISON AVE E STE D",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833016749",
"telephone_number": "208-814-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "TYLER",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-11",
"last_updated": "2018-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ID",
"license": "OTL- 1765",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.