Individual
BRIAN KINGSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 359-9570
(208) 359-9580
Mailing address
36 PROFESSIONAL PLZ, STE 110, REXBURG, ID 83440-2049
(208) 359-9570
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-482
ID
Other
Enumeration date
02/11/2009
Last updated
11/26/2018
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