Individual
KERRI LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
2200 IRONWOOD PL, COEUR D ALENE, ID 83814-2610
(208) 667-6486
(208) 664-3459
Mailing address
801 N C ST, COEUR D ALENE, ID 83814-2220
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-812
ID
225XP0200X
Pediatric Occupational Therapist
OT3934
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135053
MEDICARE PROVIDER NUMBER
ID
05
—
8407975
—
WA
Enumeration date
11/14/2006
Last updated
07/20/2007
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