Individual
LEUNG S TAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
634 TREJO ST, REXBURG, ID 83440-2579
(208) 761-0252
Mailing address
634 TREJO ST, REXBURG, ID 83440-2579
(208) 761-0252
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1064
ID
Other
Enumeration date
12/09/2012
Last updated
12/09/2012
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