Individual
BROOKE SUE RUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1460 ELK CREEK DR, IDAHO FALLS, ID 83404-8237
(208) 535-1286
Mailing address
2615 REBEL RD, AMMON, ID 83406
(208) 419-8894
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-2264
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA-2264
STATE ISSUED LICENSE
ID
Enumeration date
09/16/2021
Last updated
09/16/2021
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