Individual
PATRICK DALE RUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
166 WILDFLOWER LN, EAGLE, ID 83616-5947
(208) 794-7286
Mailing address
166 WILDFLOWER LN, EAGLE, ID 83616-5947
(208) 794-7286
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
14-1230
NV
224Z00000X
Occupational Therapy Assistant
295012
OR
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1139
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-1230
STATE OF NEVADA, BOARD OF OCCUPATIONAL THERAPY
NV
01
—
295012
STATE OF OREGON, OCCUPATIONAL THERAPY LICENSING BOARD
OR
01
—
OTA-1139
STATE OF IDAHO, BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
12/09/2014
Last updated
12/09/2014
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