Individual
JACOB ANDREW BELLOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
120 E HOWARD ST, DRIGGS, ID 83422-5112
(208) 354-2383
Mailing address
759 N SKYLINE DR, IDAHO FALLS, ID 83402-2663
(209) 345-6270
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2592
ID
225XG0600X
Gerontology Occupational Therapist
OT-2592
ID
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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