Active NPI
Jake Bundy, MOTR/L
- Occupational Therapist
- Pocatello, ID
National Provider Identifier
1972005361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-1457
- Practice address
- 560 Memorial Dr Ste B
Pocatello, ID 83201-4073 - Phone
- (208) 235-4263
- NPI assigned
- Mar 1, 2018
- Last updated
- Mar 1, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT-1457 | ID | Primary |
Addresses
Primary practice location
560 Memorial Dr Ste B
Pocatello, ID 83201-4073
Mailing address
5082 Brylee Way
Iona, ID 83427-4908
Phone (435) 669-2438
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-1457 | ID | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519862400000",
"number": "1972005361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5082 BRYLEE WAY",
"city": "IONA",
"state": "ID",
"postal_code": "834274908",
"telephone_number": "435-669-2438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 MEMORIAL DR STE B",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014073",
"telephone_number": "208-235-4263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNDY",
"first_name": "JAKE",
"credential": "MOTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-01",
"last_updated": "2018-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ID",
"license": "OT-1457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.