Provider Demographics
NPI:1609581677
Name:NORTH IDAHO MOBILE OT
Entity Type:Organization
Organization Name:NORTH IDAHO MOBILE OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-819-2554
Mailing Address - Street 1:5925 W RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7705
Mailing Address - Country:US
Mailing Address - Phone:208-819-2554
Mailing Address - Fax:
Practice Address - Street 1:5925 W RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-7705
Practice Address - Country:US
Practice Address - Phone:208-819-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service