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Individual

BRENT RANDALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
302 GARNET DR, KIMBERLY, ID 83341-1931
(208) 731-9799
Mailing address
414 N LINCOLN AVE STE 5, JEROME, ID 83338-2300

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-556
ID

Other

Enumeration date
05/29/2008
Last updated
05/29/2008
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