Maresa Black, MOT, OTR/L
Individual provider Active NPI Pediatric Occupational Therapist · Sandpoint, ID
NPI 1750758702 · NPPES record last updated May 13, 2016
Key facts
- NPI
- 1750758702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- OT-1405 (ID)
- Practice address
- 506 Alder St FL 2
Sandpoint, ID 83864-1567 - Phone
- (208) 627-8615
- Fax
- (208) 441-2641
- NPI assigned
- Aug 25, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| OT-1405 | ID | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Journey Pediatric Therapy | Pediatrics | Current |
Accepting new patients |
Locations
506 Alder St
Fl 2
Sandpoint, ID 83864
Phone (208) 627-8615
1009 Highway 2
Ste C
Sandpoint, ID 83864
Phone (208) 627-8615
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT-1405 | ID | Yes |
Addresses
Primary practice location
506 Alder St FL 2
Sandpoint, ID 83864-1567
Mailing address
PO Box 2476
Sandpoint, ID 83864-0914
Phone (208) 627-8615
Other providers in Sandpoint, ID
- Judy Ann Bell
- Shawna Elisa Benner-Erickson
- Tara Bennion
- Sharon L Bistodeau
- James Michael Bittinger
- Russell R Blakeley
- Robert Edward Blomquist
- Blue Iris Physical Therapy
- BNG Health Services, LLC.
- Aarow Bond Ellis
All providers in Sandpoint, 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 May 13, 2016. 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.