Individual
JESSICA PORTER COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 359-9570
Mailing address
175 STOCKHAM BLVD APT 2, RIGBY, ID 83442-1283
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTL- 1609
ID
Other
Enumeration date
05/28/2016
Last updated
10/25/2017
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