Provider Demographics
NPI:1356887301
Name:PURVIS, JARED AUSTIN (OTL)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:AUSTIN
Last Name:PURVIS
Suffix:
Gender:M
Credentials:OTL
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Other - First Name:
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Mailing Address - Street 1:1886 S PELICAN AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4747
Mailing Address - Country:US
Mailing Address - Phone:208-870-3258
Mailing Address - Fax:
Practice Address - Street 1:3368 E GOLDSTONE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1026
Practice Address - Country:US
Practice Address - Phone:208-899-7992
Practice Address - Fax:208-795-8927
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDOTL-1705225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics