Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12326494-4201 | UT |
NPI | 1356917322 |
---|---|
Provider Name | Analena Holihan |
First Address | Salt Lake City, UT 84101-1828 |
Second Address | Clearfield, UT 84015-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2021 |
Last Update Date | 01/06/2021 |