Provider Demographics
NPI:1508267915
Name:SUPERSTARS OCCUPATIONAL THERAPY FOR KIDS
Entity Type:Organization
Organization Name:SUPERSTARS OCCUPATIONAL THERAPY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-457-8072
Mailing Address - Street 1:2422 PARTRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4944
Mailing Address - Country:US
Mailing Address - Phone:208-457-8072
Mailing Address - Fax:
Practice Address - Street 1:2422 PARTRIDGE LOOP
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4944
Practice Address - Country:US
Practice Address - Phone:208-819-9362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren