# BEACON THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184559031
- **Authorized official:** MR. GARY H WILLIS II OT (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (208) 604-0800

## Contact information

- **Practice address:** 151 N 4TH AVE STE A, POCATELLO, ID 83201-6300
- **Practice address phone:** (208) 604-0800
- **Mailing address:** 1030 STARS RD, CHUBBUCK, ID 83202-1982
- **Mailing address phone:** (208) 604-0800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |
| 225XE0001X | Environmental Modification Occupational Therapist | — | NULL | — |
| 225XE0001X | Environmental Modification Occupational Therapist | — | — | — |
| 225XE1200X | Ergonomics Occupational Therapist | — | NULL | — |
| 225XE1200X | Ergonomics Occupational Therapist | — | — | — |
| 225XG0600X | Gerontology Occupational Therapist | — | NULL | — |
| 225XG0600X | Gerontology Occupational Therapist | — | — | — |
| 225XH1300X | Human Factors Occupational Therapist | — | NULL | — |
| 225XH1300X | Human Factors Occupational Therapist | — | — | — |
| 225XM0800X | Mental Health Occupational Therapist | — | NULL | — |
| 225XM0800X | Mental Health Occupational Therapist | — | — | — |
| 225XN1300X | Neurorehabilitation Occupational Therapist | — | NULL | — |
| 225XN1300X | Neurorehabilitation Occupational Therapist | — | — | — |
| 225XP0019X | Physical Rehabilitation Occupational Therapist | — | NULL | — |
| 225XP0019X | Physical Rehabilitation Occupational Therapist | — | — | — |
| 225XP0200X | Pediatric Occupational Therapist | — | NULL | — |
| 225XP0200X | Pediatric Occupational Therapist | — | — | — |
| 225XR0403X | Driving and Community Mobility Occupational Therapist | — | NULL | — |
| 225XR0403X | Driving and Community Mobility Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 06/15/2026
- **Last updated:** 06/15/2026