Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT535 | ID |
NPI | 1003081670 |
---|---|
Provider Name | Bradley Saunders |
First Address | Rexburg, ID 83440-2048 |
Second Address | Rexburg, ID 83440-2048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |