Individual
HENRY GERARD JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
614 BURRELL DR, LEWISTON, ID 83501-5120
(208) 792-1808
Mailing address
614 BURRELL DR, LEWISTON, ID 83501-5120
(208) 792-1808
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
ID
Other
Enumeration date
12/02/2018
Last updated
12/02/2018
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