Provider Demographics
NPI:1558539122
Name:BUILDING BLOCKS OCCUPATIONAL THERAPY, INC
Entity Type:Organization
Organization Name:BUILDING BLOCKS OCCUPATIONAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-374-4911
Mailing Address - Street 1:398 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3537
Mailing Address - Country:US
Mailing Address - Phone:907-374-4911
Mailing Address - Fax:907-374-4934
Practice Address - Street 1:398 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4760
Practice Address - Country:US
Practice Address - Phone:907-374-4911
Practice Address - Fax:907-374-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1106261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021147Medicaid