Dayna K. Willbanks, OTR/L – Occupational Therapist

Key facts

NPI: 1841340486
Entity type: Individual (NPI type 1)
Primary specialty: Occupational Therapist 225X00000X
License: OT406 (ID)
Practice address: 106 E 3Rd St
Moscow, ID 83843-2970
Phone: (509) 432-1575
Fax: (509) 332-8045
NPI assigned: Jan 12, 2007
Sex: Female
Sole proprietor: Yes

Organizations & group practices 2

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.

BK Inc. Physical Therapy Clinic/Center · Moscow, ID · NPI 1659429405

NPD (past)
Synergy Healthcare Inc. Physical Therapist · Spokane Valley, WA · NPI 1780741439

NPD (past)

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
OT406	ID	MD	Occupational Therapist

Practice roles

Organization	Specialty	Status	New patients
Synergy Healthcare Inc.		Past	Accepting new patients
BK Inc.		Past since Apr 1, 2007	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Occupational Therapist	225X00000X	OT406	ID	Yes

Addresses

Primary practice location

106 E 3Rd St
Moscow, ID 83843-2970

Mailing address

455 NW Robert St
Pullman, WA 99163-3640
Phone (509) 432-1575

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 31, 2010.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1841340486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 NW ROBERT ST",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991633640",
            "telephone_number": "509-432-1575",
            "fax_number": "509-332-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E 3RD ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432970",
            "telephone_number": "509-432-1575",
            "fax_number": "509-332-8045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLBANKS",
        "first_name": "DAYNA",
        "middle_name": "K.",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

All providers in Moscow, 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 Aug 31, 2010. 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.