Individual
DEREK BAWDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 910-2360
Mailing address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 910-2360
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT-984
ID
225XP0200X
Pediatric Occupational Therapist
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Other
Enumeration date
06/22/2010
Last updated
06/08/2022
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