MEDICARE: MISSY RENEE STURK M.S., OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	OT-965	ID

General Provider Information

NPI Number	:	1811211527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISSY RENEE STURK M.S., OTR/L

Provider Business Mailing Address
First Line	:	7898 HOUSE TOP LN
Second Line	:
City	:	VICTOR
State	:	ID
Zip	:	83455-4958
Country	:	US
Telephone Number	:	208-520-5672
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 N MAIN ST
Second Line	:
City	:	DRIGGS
State	:	ID
Zip	:	83422-5125
Country	:	US
Telephone Number	:	208-520-5672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	04/10/2026

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