Provider Demographics
NPI:1649966482
Name:ROTHIE, REBECCA MCKAYL
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MCKAYL
Last Name:ROTHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 E TALL TIMBER LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7282
Mailing Address - Country:US
Mailing Address - Phone:406-381-1610
Mailing Address - Fax:
Practice Address - Street 1:2772 W AVANTE LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-0333
Practice Address - Country:US
Practice Address - Phone:406-381-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist