Healthcare Provider Details

I. General information

NPI: 1811211527
Provider Name (Legal Business Name): MISSY RENEE STURK M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA RENEE STURK MS, OTR/L

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1ST ST
DRIGGS ID
83422-5219
US

IV. Provider business mailing address

7898 HOUSE TOP LN
VICTOR ID
83455-4958
US

V. Phone/Fax

Practice location:
  • Phone: 208-435-8846
  • Fax:
Mailing address:
  • Phone: 208-520-5672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-965
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: