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1972005361
JAKE BUNDY
POCATELLO, ID
NPI
1972005361
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: ID OT-1457)
Enumeration Date
2018-03-01
Last Update Date
2018-03-01
Business Address
JAKE BUNDY MOTR/L
560 MEMORIAL DR STE B
POCATELLO, ID 83201-4073
Phone number: 208-235-4263
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Mailing Address
JAKE BUNDY MOTR/L
5082 BRYLEE WAY
IONA, ID 83427-4908
Phone number: 435-669-2438
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