Individual
WILLIAM BRENT GRIFFETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2037 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 529-3355
(208) 529-9581
Mailing address
2037 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 529-3355
(208) 529-9581
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT347
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010022488
BLUE SHIELD
ID
01
—
W0673
BLUE CROSS
ID
Enumeration date
12/18/2006
Last updated
07/08/2007
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