Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 9099793-4201 | UT |
NPI | 1003216367 |
---|---|
Provider Name | Adam Porter |
First Address | Salt Lake City, UT 84132-0001 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2014 |
Last Update Date | 01/12/2021 |