Stacy J Gardner – Pediatric Occupational Therapist

Key facts

NPI: 1669239133
Entity type: Individual (NPI type 1)
Primary specialty: Pediatric Occupational Therapist 225XP0200X
License: OT988 (ID)
Practice address: 650 N State St Ste 5
Shelley, ID 83274-4900
Phone: (208) 428-6079
NPI assigned: Mar 1, 2024
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

All Access Therapy Inc Pediatric Physical Therapist · Shelley, ID · NPI 1154091874

NPD PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
OT988	ID	MD	Pediatric Occupational Therapist

Practice roles

Organization	Specialty	Status	New patients
All Access Therapy Inc	Pediatrics	Current since Mar 3, 2024	Accepting new patients

Locations

650 N State St
Ste 5
Shelley, ID 83274
Phone (208) 221-4677

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Occupational Therapist	225XP0200X	OT988	ID	Yes

Addresses

Primary practice location

650 N State St Ste 5
Shelley, ID 83274-4900

Mailing address

650 N State St Ste 5
Shelley, ID 83274-4900
Phone (208) 428-6079

Other names

Stacy J Rauenhorst Former name

Other providers in Shelley, ID

All providers in Shelley, 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 Mar 1, 2024. 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.