Provider Demographics
NPI:1295718948
Name:TAFT, VIRGINIA (OTR-L)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:TAFT
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 MERRITT CREEK LOOP
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4953
Mailing Address - Country:US
Mailing Address - Phone:208-664-2901
Mailing Address - Fax:208-667-9266
Practice Address - Street 1:2448 MERRITT CREEK LOOP
Practice Address - Street 2:SUITE 2A
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4953
Practice Address - Country:US
Practice Address - Phone:208-664-2901
Practice Address - Fax:208-667-9266
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-0534955OtherSTERLING
82-0534955OtherSTATE INS FUND
20782OtherGROUP HEALTH
QMXPR0060660OtherMOLINA
820534955OtherIPN
82053495583814A002OtherTRIWEST/TRICARE
ID907654145Medicaid
185598800OtherFEDERAL L&I
5003984OtherREGENCE MEDADVANTAGE
DA3588OtherRAILROAD MEDICARE
W0640OtherBLUE CROSS
000010020481OtherBLUE SHIELD
066519OtherWA L&I
60259OtherFIRST CHOICE
820534955OtherIPN
ID907654145Medicaid