Provider Demographics
NPI:1356026884
Name:NUFFER, KELSEY LYNN (OTA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:NUFFER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LYNN
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 CEDAR PARK LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8476
Mailing Address - Country:US
Mailing Address - Phone:208-948-0077
Mailing Address - Fax:
Practice Address - Street 1:2127 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3149
Practice Address - Country:US
Practice Address - Phone:208-321-4898
Practice Address - Fax:208-321-4859
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTAL-2773224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant