Individual
IVAN M HARDCASTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOT
Contact information
Practice address
276 EASTLAND DR N STE A, TWIN FALLS, ID 83301-4458
(208) 308-4661
(208) 736-0890
Mailing address
276 EASTLAND DR N STE A, TWIN FALLS, ID 83301-4458
(208) 308-4661
(208) 736-0890
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-831
ID
225X00000X
Occupational Therapist
OTLP240
ID
Other
Enumeration date
05/03/2007
Last updated
05/24/2023
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