Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 11355367-4201 | UT |
NPI | 1114579869 |
---|---|
Provider Name | Dr. Brian David Jensen |
First Address | Layton, UT 84041-4974 |
Second Address | Layton, UT 84041-4974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 12/07/2019 |