Provider Demographics
NPI:1356827893
Name:RUPE, DONALD SHELBY (OT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:SHELBY
Last Name:RUPE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:SHELBY
Other - Last Name:RUPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:14455 W COMISKY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0966
Mailing Address - Country:US
Mailing Address - Phone:208-319-4981
Mailing Address - Fax:
Practice Address - Street 1:9850 ST LUKES DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7912
Practice Address - Country:US
Practice Address - Phone:208-319-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist