Derek Bawden, OT

Primary specialty

SpecialistTaxonomy code 174400000X

License

OT-984 Issued in ID

Practice address

1031 W Sanetta St
Nampa, ID 83651-5047

Phone

(208) 910-2360

NPI assigned

Jun 22, 2010

Sex

Male

Sole proprietor

Yes

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

Practice roles

Locations

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.

• Odyssey Pediatric Therapy Specialists, LLC

  • Pediatric Occupational Therapist
  • Nampa, ID
  • NPI 1043949696

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1831410083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 W SANETTA ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836515047",
            "telephone_number": "208-910-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 W SANETTA ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836515047",
            "telephone_number": "208-910-2360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6855 W Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837048046",
            "country_code": "US",
            "telephone_number": "208-323-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAWDEN",
        "first_name": "DEREK",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-22",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "OT-984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allyson Anne Bates, FNP-BC
• Kathryn Therese Battaglia, MOT, OTR/L
• Brianna Battles, NP
• Karl Baumgartner, LMSW
• Sarah A Bausman, CPM
• Brent Baxter, PHARM D
• Alison Ann Bayne, COTA
• Allison Beaman, APRN, FNP-C
• Bear Home Health
• Hollie Bearce, MD

• All providers in Nampa, ID
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.