Provider Demographics
NPI:1568063501
Name:MASON, KAMI LUANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAMI
Middle Name:LUANNE
Last Name:MASON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:LUANNE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6270 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON GARDENS
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:541-663-7111
Mailing Address - Fax:
Practice Address - Street 1:6270 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-9214
Practice Address - Country:US
Practice Address - Phone:208-666-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist