Provider Demographics
NPI:1699056580
Name:ERICA SCHUPPE, DBA
Entity type:Organization
Organization Name:ERICA SCHUPPE, DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:SCHUPPE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:406-652-3730
Mailing Address - Street 1:2500 GRAND AVE STE R
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7103
Mailing Address - Country:US
Mailing Address - Phone:406-652-3720
Mailing Address - Fax:
Practice Address - Street 1:2500 GRAND AVE STE R
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7103
Practice Address - Country:US
Practice Address - Phone:406-652-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT897225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT197999Medicaid