Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 9459049-4202 | UT |
NPI | 1275154767 |
---|---|
Provider Name | Austin Bud Holder |
First Address | Taylorsville, UT 84129-1564 |
Second Address | Murray, UT 84107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2020 |
Last Update Date | 06/05/2020 |