Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 11511725-4201 | UT |
N | 225XE0001X | Environmental Modification | 11511725-4201 | UT |
N | 2251E1200X | Ergonomics | 11511725-4201 | UT |
N | 225XE1200X | Ergonomics | 11511725-4201 | UT |
N | 225XG0600X | Occupational Therapist - Gerontology | 11511725-4201 | UT |
N | 225XL0004X | Low Vision | 11511725-4201 | UT |
N | 225XM0800X | Mental Health | 11511725-4201 | UT |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 11511725-4201 | UT |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11511725-4201 | UT |
N | 225XP0200X | Occupational Therapist - Pediatrics | 11511725-4201 | UT |
N | 225XR0403X | Driving and Community Mobility | 11511725-4201 | UT |
NPI | 1891335279 |
---|---|
Provider Name | Dr. Gessica Dian Stovall |
First Address | Sandy, UT 84092-1237 |
Second Address | Murray, UT 84107-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2020 |
Last Update Date | 13/01/2020 |