Individual
MS. AJ JAQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
510 E 17TH ST # 400, IDAHO FALLS, ID 83404-6154
(208) 589-0807
(208) 542-9577
Mailing address
4434 E 400 N, RIGBY, ID 83442-5525
(208) 745-9046
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-282
ID
Other
Enumeration date
10/13/2006
Last updated
07/08/2007
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