Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT60391253 | WA |
NPI | 1003217951 |
---|---|
Provider Name | Aloe Otte |
First Address | Salt Lake City, UT 84171-1185 |
Second Address | Salt Lake City, UT 84121-6877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 10/09/2014 |