Healthcare Provider Details

I. General information

NPI: 1942362025
Provider Name (Legal Business Name): SUSAN MARY QUINN HURST OTR/L, BCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PINE ST
SANDPOINT ID
83864-1832
US

IV. Provider business mailing address

PO BOX 2546
SANDPOINT ID
83864-0917
US

V. Phone/Fax

Practice location:
  • Phone: 208-304-0652
  • Fax:
Mailing address:
  • Phone: 208-263-6348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1265
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: