Individual
MISS JESSICA BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
510 E 17TH ST, IDAHO FALLS, ID 83404-6154
(208) 589-9578
(208) 542-9577
Mailing address
3841 E 38 N, RIGBY, ID 83442-5708
(208) 745-9373
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-779
ID
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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