Active NPI
Elliot Starcevich, OTR/L
- Pediatric Occupational Therapist
- Meridian, ID
National Provider Identifier
1417476474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 1608
- Practice address
- 68 S Baltic PL
Meridian, ID 83642-5935 - Phone
- (208) 898-0988
- NPI assigned
- Sep 11, 2017
- Last updated
- Sep 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 1608 | ID | Primary |
Addresses
Primary practice location
68 S Baltic PL
Meridian, ID 83642-5935
Mailing address
651 S Walnut Ave # D226
New Braunfels, TX 78130-5722
Phone (512) 576-9884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171206001779 | ID | Practitioner - Occupational Therapist in Private Practice | 5799042321 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1608 | ID | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505088000000",
"number": "1417476474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "651 S WALNUT AVE # D226",
"city": "NEW BRAUNFELS",
"state": "TX",
"postal_code": "781305722",
"telephone_number": "15125769884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 S BALTIC PL",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836425935",
"telephone_number": "208-898-0988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARCEVICH",
"first_name": "ELLIOT",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-09-11",
"last_updated": "2017-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "ID",
"license": "1608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.