Individual provider Active NPI

Linda M. Henrikson, COTA L

  • Specialist
  • Boise, ID
National Provider Identifier
1992913446
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
OTA082 Issued in ID
Practice address
1130 Allumbaugh St
Boise, ID 83704-8700
Phone
(208) 854-8517
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X OTA082 ID Primary

Addresses

Primary practice location

1130 Allumbaugh St
Boise, ID 83704-8700

Mailing address

6122 Glencrest Ave
Boise, ID 83714-6103
Phone (208) 853-7788

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

LicenseStateTypeSpecialty
OTA082IDMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992913446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6122 GLENCREST AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837146103",
            "telephone_number": "208-853-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 ALLUMBAUGH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048700",
            "telephone_number": "208-854-8517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIKSON",
        "first_name": "LINDA",
        "middle_name": "M.",
        "credential": "COTA L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "OTA082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.