Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 102529624201 | UT |
NPI | 1104319847 |
---|---|
Provider Name | Brittney Marie Passman |
First Address | Salt Lake City, UT 84102-1507 |
Second Address | Salt Lake City, UT 84102-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 07/06/2018 |