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1174374557
JOSHUA BARNETT WILDE
IDAHO FALLS, ID
NPI
1174374557
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225XP0200X Occupational Therapist, Pediatrics
(Licence: ID OT-2839)
Enumeration Date
2024-04-01
Last Update Date
2024-04-01
Business Address
JOSHUA BARNETT WILDE
1460 ELK CREEK DR
IDAHO FALLS, ID 83404-8237
Phone number: 208-535-1286
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Mailing Address
JOSHUA BARNETT WILDE
1460 ELK CREEK DR
IDAHO FALLS, ID 83404-8237
Phone number: 208-535-1286
Copy
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