Individual
AUSTIN WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
881 JAMES ST, BLACKFOOT, ID 83221-3919
(435) 770-5499
Mailing address
881 JAMES ST, BLACKFOOT, ID 83221-3919
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1073
ID
Other
Enumeration date
02/10/2012
Last updated
02/10/2012
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