Cody Funk

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

60976943 Issued in WA

Practice address

2902 Seaport Dr
Lewiston, ID 83501-8619

Phone

(208) 852-6705

NPI assigned

Jan 11, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1689388944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 SEAPORT DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835018619",
            "telephone_number": "208-852-6705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 SEAPORT DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835018619",
            "telephone_number": "208-852-6705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNK",
        "first_name": "CODY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ID",
            "license": "2070",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WA",
            "license": "60976943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaytie Friesen, BSW, BIS, IP
• Full Potential Physical Therapy, PLLC
• Codi Fuller, D.C.
• Steve Fuller
• Rebecca L. Fulton, MD
• Julie Len Funke, FNP
• Katherine A Gage, MSW LCSW
• Galen K. Haas DDS PA
• Cory A Gall, PHD
• Richard Ballou Gallaher Jr., PHD

• Pediatric Occupational Therapist in Lewiston, ID
• Providers in Lewiston, 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 Jan 11, 2023; 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.