Provider Demographics
NPI:1942362025
Name:QUINN HURST, SUSAN MARY (OTR/L, BCP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:QUINN HURST
Suffix:
Gender:F
Credentials:OTR/L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0917
Mailing Address - Country:US
Mailing Address - Phone:208-263-6348
Mailing Address - Fax:
Practice Address - Street 1:1001 PINE ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1832
Practice Address - Country:US
Practice Address - Phone:208-304-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK201752356OtherTAX ID
WAOT00000844OtherOT LICENSE
IDOT-816OtherOT LICENSE
AKOT4752Medicaid
WAOT00000844OtherOT LICENSE