Active NPI
Brian Mitchell Wilson, OTR
- Occupational Therapist
- Nampa, ID
National Provider Identifier
1235895319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-2031
- Practice address
- 9850 W St Lukes Dr
Nampa, ID 83687-7912 - Phone
- (469) 585-5771
- NPI assigned
- Nov 12, 2021
- 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 | OT-2031 | ID | Primary |
Addresses
Primary practice location
9850 W St Lukes Dr
Nampa, ID 83687-7912
Mailing address
9850 W St Lukes Dr
Nampa, ID 83687-7912
Phone (469) 585-5771
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 |
|---|---|---|---|
| OT-2031 | ID | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1235895319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9850 W ST LUKES DR",
"city": "NAMPA",
"state": "ID",
"postal_code": "836877912",
"telephone_number": "469-585-5771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9850 W ST LUKES DR",
"city": "NAMPA",
"state": "ID",
"postal_code": "836877912",
"telephone_number": "469-585-5771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BRIAN",
"middle_name": "MITCHELL",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-12",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ID",
"license": "OT-2031",
"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 Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.