Provider Demographics
NPI:1699451906
Name:RUSHTON, NADILYN MICHELLE (OTL-2777)
Entity type:Individual
Prefix:
First Name:NADILYN
Middle Name:MICHELLE
Last Name:RUSHTON
Suffix:
Gender:F
Credentials:OTL-2777
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CALL CREEK DR STE 7
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3072
Mailing Address - Country:US
Mailing Address - Phone:208-233-4660
Mailing Address - Fax:208-233-4262
Practice Address - Street 1:1110 CALL CREEK DR STE 7
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3072
Practice Address - Country:US
Practice Address - Phone:208-233-4660
Practice Address - Fax:208-233-4262
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTL-2777225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics