Individual
SCOTT G. STEVENS
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) 234-9344
Mailing address
2463 DIANE LN, POCATELLO, ID 83201-1906
(208) 234-9344
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT569
ID
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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