Bounce Back OT LLC
Organization Active NPI Occupational Therapist · Rexburg, ID
NPI 1831949288 · NPPES record last updated Dec 19, 2025
Key facts
- NPI
- 1831949288
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Occupational Therapist 225X00000X
- Legal business name
- BOUNCE BACK OT LLC
- Practice address
- 6070 S 2000 W
Rexburg, ID 83440-4441 - Phone
- (208) 356-3340
- Fax
- (833) 520-1454
- NPI assigned
- Mar 26, 2024
- Organization subpart
- No
Authorized official
- Name
- Amanda Lagerstrom, MOTL/R
- Title
- Occupational Therapist
- Phone
- (208) 356-3340
Practitioners 1
-
Amanda Lagerstrom, MOT OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260106003880 | ID | Part B Supplier - Clinic/Group Practice | 4789170010 |
Receives reassigned benefits from 1 practitioner Practice locations: Rexburg, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist |
225X00000X | Yes |
Addresses
Primary practice location
6070 S 2000 W
Rexburg, ID 83440-4441
Mailing address
6070 S 2000 W
Rexburg, ID 83440-4441
Phone (208) 356-3340
Other providers in Rexburg, ID
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- Britney J Bochenek
- Cleo Celine Bohney
- Boost Ventures PLLC
- David George Booth
- Danielle Bowen
- Kreed Bowman
- Brad Egbert Chiropractic LLC
- Dustin Zachary Brady
- Debra Brand
All providers in Rexburg, ID · 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 Dec 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.