Provider Demographics
NPI:1407602261
Name:UPTREAM LIVING SOLUTIONS & MOBILE THERAPY LLC
Entity type:Organization
Organization Name:UPTREAM LIVING SOLUTIONS & MOBILE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDAMA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CAPS, ECHM
Authorized Official - Phone:208-421-9775
Mailing Address - Street 1:511 SUNRISE BLVD N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4350
Mailing Address - Country:US
Mailing Address - Phone:208-421-6775
Mailing Address - Fax:
Practice Address - Street 1:511 SUNRISE BLVD N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4350
Practice Address - Country:US
Practice Address - Phone:208-421-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty