Individual
ERIC WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4 N 740 W, BLACKFOOT, ID 83221-5340
(208) 684-4077
Mailing address
PO BOX 293, BLACKFOOT, ID 83221-0293
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
NBCOT 277538/NOSTATE
ID
Other
Enumeration date
10/19/2010
Last updated
01/22/2013
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