NPIMap

Organization Active NPI

Idaho Therapy Source

  • Occupational Therapist
  • Nampa, ID
National Provider Identifier
1235461732
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT-663 Issued in ID
Legal business name
IDAHO THERAPY SOURCE
Practice address
1812 N Midland Blvd
Nampa, ID 83651-1747
Phone
(208) 412-6919
NPI assigned
Feb 8, 2010
Last updated
Feb 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Authorized official

Name
Christine M Dickens, OT
Title
Sole Member/OT
Phone
(208) 467-9117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X OT-663 ID Primary

Addresses

Primary practice location

1812 N Midland Blvd
Nampa, ID 83651-1747

Mailing address

10984 W Box Canyon St
Star, ID 83669-5691
Phone (208) 412-6919

National Provider Directory

National Provider Directory

Locations

16171 N Brinson St
Nampa, ID 83687
Phone (208) 442-2525

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1235461732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10984 W BOX CANYON ST",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695691",
            "telephone_number": "208-412-6919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 N MIDLAND BLVD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836511747",
            "telephone_number": "208-412-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO THERAPY SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE MEMBER/OT",
        "authorized_official_telephone_number": "208-467-9117",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; 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.