Provider Demographics
NPI:1447343462
Name:SEARGENT, JANICE KYTLE (MED OTR/L-ATP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:KYTLE
Last Name:SEARGENT
Suffix:
Gender:F
Credentials:MED OTR/L-ATP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1820 E 17TH STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6472
Mailing Address - Country:US
Mailing Address - Phone:208-529-3358
Mailing Address - Fax:208-529-3382
Practice Address - Street 1:1820 E 17TH STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6472
Practice Address - Country:US
Practice Address - Phone:208-529-3358
Practice Address - Fax:208-529-3382
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDOT009225CA2400X, 225400000X, 225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics