Individual
GARY HOWARD WILLIS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
4473 FOX CT, CHUBBUCK, ID 83202-2670
(208) 604-0800
(208) 232-5770
Mailing address
716 WYLDWOOD LN, POCATELLO, ID 83201-3644
(208) 604-0800
(208) 232-5770
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT593
ID
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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