Individual
ALICIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2327 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 680-1445
Mailing address
4213 BARTON LN, AMMON, ID 83406-5040
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-979
ID
Other
Enumeration date
01/04/2016
Last updated
01/04/2016
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