Provider Demographics
NPI:1629645205
Name:LAPORTA, DESIRAE MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DESIRAE
Middle Name:MARIE
Last Name:LAPORTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:DESIRAE
Other - Middle Name:MARIE
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3086 W MILANO DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-996-0552
Mailing Address - Fax:208-914-6597
Practice Address - Street 1:2419 E MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6295
Practice Address - Country:US
Practice Address - Phone:916-749-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2169225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist