Jake Bundy, MOTR/L
Individual provider Active NPI Occupational Therapist · Pocatello, ID
NPI 1972005361 · NPPES record last updated Mar 1, 2018
Key facts
- NPI
- 1972005361
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT-1457 (ID)
- Practice address
- 560 Memorial Dr Ste B
Pocatello, ID 83201-4073 - Phone
- (208) 235-4263
- NPI assigned
- Mar 1, 2018
- Sex
- Male
- Sole proprietor
- Yes
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-1457 | ID | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT-1457 | ID | Yes |
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
Other providers in Pocatello, ID
- Built Physical Therapy PC
- Kenton Buitenbos
- Nicholas Freeman Bullock
- Cynthia Ann Bunde
- Jennifer Bunderson
- Gregary Gradon Burch
- Maria Florencia Burgos
- Alyssa Burgoyne
- Dulcey Larene Burkman
- Avery Marie Burnett
All providers in Pocatello, 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 Mar 1, 2018. 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.