Provider Demographics
NPI:1538355532
Name:KING, JAMES ALBERT (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALBERT
Last Name:KING
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4846 WIND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5828
Mailing Address - Country:US
Mailing Address - Phone:208-339-4300
Mailing Address - Fax:208-552-0395
Practice Address - Street 1:4846 WIND RIVER RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5828
Practice Address - Country:US
Practice Address - Phone:208-339-7234
Practice Address - Fax:208-552-0395
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003463225X00000X
IDOT-843225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist