Search icon

Odyssey Pediatric Therapy Specialists, LLC

Company claim

Is this your business?

Get access!

Company Details

Name: Odyssey Pediatric Therapy Specialists, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 09 Aug 2021 (4 years ago)
Financial Date End: 31 Aug 2025
Date dissolved: 15 Nov 2024
Entity Number: 4373924
Place of Formation: IDAHO
File Number: 776521
ZIP code: 83651
County: Canyon County
Mailing Address: DEREK BAWDEN 1031 W SANETTA ST NAMPA, ID 83651-5047

Manager

Name Role Address Appointed On
Travis Crump Manager 31 S. GRANDEAN WAY, EAGLE, ID 83616 2023-08-11
Jeramy McMillan Manager 5309 WORTH WAY, CALDWELL, ID 83607 2023-08-11
Derek Bawden Manager 4440 N. MONTELINO AVE., MERIDIAN, ID 83646 2022-04-13

Agent

Name Role Address
Derek Bawden Agent 4440 N MONTELINO AVE, MERIDIAN, ID 83646

National Provider Identifier

NPI Number:
1043949696
Certification Date:
2022-06-30

Authorized Person:

Name:
DEREK BAWDEN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
No
Selected Taxonomy:
225XF0002X - Feeding, Eating & Swallowing Occupational Therapist
Is Primary:
No
Selected Taxonomy:
235Z00000X - Speech-Language Pathologist
Is Primary:
No
Selected Taxonomy:
224Z00000X - Occupational Therapy Assistant
Is Primary:
No
Selected Taxonomy:
225XP0200X - Pediatric Occupational Therapist
Is Primary:
Yes

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
872103617
Plan Year:
2023
Number Of Participants:
0
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Application for Reinstatement 0006255096 2025-05-14
Dissolution/Revocation - Administrative 0005982433 2024-11-15
Annual Report 0005360968 2023-08-11
Annual Report 0004808245 2022-07-07
Statement of Change of Business Mailing Address 0004808220 2022-07-07

Reviews Leave a review

This company hasn't received any reviews.

Date of last update: 19 May 2025

Sources: Idaho Secretary of State