Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 311140-4201 | UT |
NPI | 1841699469 |
---|---|
Provider Name | Geoffrey Thomas Fisher |
First Address | Bountiful, UT 84011-0307 |
Second Address | Lindon, UT 84042-2078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 09/06/2015 |