Individual
MR. COURT T CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2725 E 17TH ST, AMMON, ID 83406-6601
(208) 529-4567
Mailing address
2667 AQUA MARINE DR, IDAHO FALLS, ID 83401-6228
(208) 351-1085
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT898
ID
Other
Enumeration date
03/01/2010
Last updated
03/01/2010
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