Kiley Petencin, | |
1460 Elk Creek Dr, Idaho Falls, ID 83404-8237 | |
(208) 535-1286 | |
Not Available |
Full Name | Kiley Petencin |
---|---|
Gender | Female |
Speciality | Occupational Therapist - Pediatrics |
Location | 1460 Elk Creek Dr, Idaho Falls, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1639810823 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225XP0200X | Occupational Therapist - Pediatrics | OT-1736 (Idaho) | Primary |
Provider Name | Holistic Community Therapy Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1073179776 PECOS PAC ID: 0547692618 Enrollment ID: O20191111001442 |
Mailing Address | Practice Location Address |
---|---|
Kiley Petencin, 197 E 19th St, Idaho Falls, ID 83404-6020 Ph: (434) 825-4316 | Kiley Petencin, 1460 Elk Creek Dr, Idaho Falls, ID 83404-8237 Ph: (208) 535-1286 |
Brian Lane Olson, Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 510 E 17th St # 400, Idaho Falls, ID 83404 Phone: 208-589-0807 | |
Mrs. Heidi Maxine Boyle, MOTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 3715 Woodking Dr, Idaho Falls, ID 83404 Phone: 208-529-2255 | |
Perry Rex Lords, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1460 Elk Creek Dr, Idaho Falls, ID 83404 Phone: 208-535-1286 | |
Hannah Golden, MOTR/L Occupational Therapist Medicare: Medicare Enrolled Practice Location: 1460 Elk Creek, Idaho Falls, ID 83404 Phone: 208-535-1286 | |
Nicole Taylor Kamerman, MOT/R Occupational Therapist Medicare: Medicare Enrolled Practice Location: 3814 Washington Pkwy, Idaho Falls, ID 83404 Phone: 208-360-4584 | |
Aaron Ashton May, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 3111 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-0067 | |
Caroline Olivia Menser, OTD, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1460 Elk Creek Dr, Idaho Falls, ID 83404 Phone: 208-535-1286 |