Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 113212 | TX |
N | 225X00000X | Occupational Therapist | OT 13076 | FL |
Y | 225XG0600X | Occupational Therapist - Gerontology | 7261 | NC |
NPI | 1134457831 |
---|---|
Provider Name | Amanda Weigle Nellemann |
First Address | Park City, UT 84098-5819 |
Second Address | Salt Lake City, UT 84143-4220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2009 |
Last Update Date | 09/11/2021 |