Individual
MR. WILLIAM DAVID PENTECOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
331 E PARK ST, WEISER, ID 83672-2053
(208) 549-0206
(208) 549-0536
Mailing address
1486 W COLVILLE CT, EAGLE, ID 83616-4869
(208) 954-3691
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-168
ID
Other
Enumeration date
08/13/2013
Last updated
08/13/2013
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