Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tina Renee Wayland Fuller, COTA/L

Individual provider Occupational Therapy Assistant · NPI 1922420736

Tina Renee Wayland Fuller, COTA/L is an Occupational Therapy Assistant in Mt Home, Idaho. Licensed in Idaho. Registered with an NPI since 2014.

Licensed in
ID
In the registry since
2014
What do these letters mean?
COTA/L — Certified Occupational Therapy Assistant, Licensed
An occupational therapy assistant who is both certified and state licensed.

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Practice location Address checks out

895 N 6th E
Mt Home, ID 83647-2207
Phone: (208) 580-9806
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence OTA-1095 (ID)

Record details

NPI number1922420736
Entity typeIndividual (Type 1)
GenderFemale
Credentials COTA/L
Sole proprietorNo
NPI enumeratedJanuary 13, 2014
Last updated in NPPESJanuary 13, 2014