Provider Demographics
NPI:1700336039
Name:LINDLEY KESSLER PEDIATRIC OCCUPATIONAL THERAPY SOURCE
Entity Type:Organization
Organization Name:LINDLEY KESSLER PEDIATRIC OCCUPATIONAL THERAPY SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDLEY-KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-631-7366
Mailing Address - Street 1:2811 W HEATHER PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2811 W HEATHER PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-1428
Practice Address - Country:US
Practice Address - Phone:208-631-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty