Provider Demographics
NPI:1598827701
Name:SCHUPPE, ERICA RAYE (OT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:RAYE
Last Name:SCHUPPE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:RAYE
Other - Last Name:HIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2110 OVERLAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6440
Mailing Address - Country:US
Mailing Address - Phone:406-690-3789
Mailing Address - Fax:
Practice Address - Street 1:2110 OVERLAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6440
Practice Address - Country:US
Practice Address - Phone:406-969-1795
Practice Address - Fax:406-969-1796
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT897225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT81-0534155OtherSCOTTISH RITE LANGUAGE CL