Palouse Ridge Occupational Therapy PLLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Legal business name

PALOUSE RIDGE OCCUPATIONAL THERAPY PLLC

Practice address

510 Elm St
Potlatch, ID 83855

Phone

(208) 669-3186

Fax

(208) 747-0782

NPI assigned

Apr 13, 2022

Last updated

Apr 13, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amanda BlackNPI 1992362818

Title

Occupational Therapist

Phone

(208) 669-3186

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Amanda Black, MOT, OTR/L

  • Occupational Therapist
  • Potlatch, ID
  • NPI 1992362818

  Pediatrics

  NPD Authorized official

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1609518166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 GRANGE PARK RD",
            "city": "PRINCETON",
            "state": "ID",
            "postal_code": "838575500",
            "telephone_number": "208-669-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 ELM ST",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "83855",
            "telephone_number": "208-669-3186",
            "fax_number": "208-747-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALOUSE RIDGE OCCUPATIONAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "208-669-3186"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael S. Hess, R.PH.
• Lindsay Ranaye Lisher
• Northwest Clinical Services
• Northwest Pharmacy Services Inc (Northwest Pharmacy)
• Northwest Pharmacy Services, Inc.
• Suzanne Paul, M.D.
• Potlatch Family Dental, PC
• Potlatch Rural Fire Dist
• Anne M White, LICSW
• Skyler S Worthington, PA-C

• Pediatric Occupational Therapist in Potlatch, ID
• Providers in Potlatch, ID by specialty
• Pediatric Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.