Palouse Ridge Occupational Therapy PLLC

Key facts

NPI: 1609518166
Entity type: Organization (NPI type 2)
Primary specialty: Pediatric Occupational Therapist 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
Organization subpart: No

Authorized official

Name: Amanda Black NPI 1992362818
Title: Occupational Therapist
Phone: (208) 669-3186

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Amanda Black, MOT, OTR/L Occupational Therapist · Potlatch, ID · NPI 1992362818

NPD Authorized official PEDIATRICS

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Occupational Therapist Group: 193400000X SINGLE SPECIALTY GROUP	225XP0200X			Yes

Addresses

Primary practice location

510 Elm St
Potlatch, ID 83855

Mailing address

1026 Grange Park Rd
Princeton, ID 83857-5500
Phone (208) 669-3186

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 13, 2022.

{
    "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": []
}

Other providers in Potlatch, ID

All providers in Potlatch, ID · Pediatric Occupational Therapist in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.