Individual
JESSICA M DIVIESTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
935 SAFSTROM DR, IDAHO FALLS, ID 83401-4107
(208) 520-2120
Mailing address
935 SAFSTROM DR, IDAHO FALLS, ID 83401-4107
(208) 520-2120
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-820
ID
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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