Individual
JAKE BUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOTR/L
Contact information
Practice address
560 MEMORIAL DR STE B, POCATELLO, ID 83201-4073
(208) 235-4263
Mailing address
5082 BRYLEE WAY, IONA, ID 83427-4908
(435) 669-2438
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1457
ID
Other
Enumeration date
03/01/2018
Last updated
03/01/2018
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