Individual
MR. TERRANCE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1375 W 3600 S, REXBURG, ID 83440-4107
(208) 356-4253
Mailing address
1375 W 3600 S, REXBURG, ID 83440-4107
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-732
ID
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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