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Individual

MR. BRANDON FOWLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
775 POLE LINE RD W STE 307, TWIN FALLS, ID 83301-5823
(208) 814-1000
Mailing address
775 POLE LINE RD W STE 307, TWIN FALLS, ID 83301-5823
(208) 814-1000

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTL-2379
ID

Other

Enumeration date
05/06/2021
Last updated
05/06/2021
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