Provider Demographics
NPI:1083262042
Name:KOKUA REHABILITATION
Entity Type:Organization
Organization Name:KOKUA REHABILITATION
Other - Org Name:HAND & UPPER EXTREMITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L, CHT
Authorized Official - Phone:208-680-1838
Mailing Address - Street 1:444 HOSPITAL WAY STE 720
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2717
Mailing Address - Country:US
Mailing Address - Phone:208-478-0258
Mailing Address - Fax:
Practice Address - Street 1:444 HOSPITAL WAY STE 720
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2717
Practice Address - Country:US
Practice Address - Phone:208-478-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty