Provider Demographics
NPI:1538205299
Name:BAYNE, ALISON ANN (COTA)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:ANN
Last Name:BAYNE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:ANN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:433 FALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-573-0617
Mailing Address - Fax:208-465-4953
Practice Address - Street 1:1127 CALDWELL BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-465-4935
Practice Address - Fax:208-465-4935
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant