Individual
MR. JONATHAN CHIDESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
36 PROFESSIONAL PLZ STE 110, REXBURG, ID 83440-2049
(208) 359-9570
(208) 359-9580
Mailing address
4105 E 525 N, RIGBY, ID 83442-5214
(208) 705-5222
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-756
ID
Other
Enumeration date
11/28/2006
Last updated
08/01/2019
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