Organization
ODYSSEY PEDIATRIC THERAPY SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK BAWDEN MOT, OTR/L (OWNER)
(801) 815-4105
Entity
Organization
Contact information
Practice address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 910-2360
Mailing address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 910-2360
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
06/08/2022
Last updated
06/30/2022
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