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1740730811
NICHOLE CHAUNTELLE WILSON
IDAHO FALLS, ID
NPI
1740730811
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
222Q00000X Developmental Therapist
Enumeration Date
2016-10-12
Last Update Date
2016-10-12
Business Address
NICHOLE CHAUNTELLE WILSON
150 SHOUP AVE
IDAHO FALLS, ID 83402-3657
Phone number: 208-359-4778
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Mailing Address
NICHOLE CHAUNTELLE WILSON
150 SHOUP AVE
IDAHO FALLS, ID 83402-3657
Phone number: 208-359-4778
Copy
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