Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 8395556-4201 | UT |
NPI | 1063761914 |
---|---|
Provider Name | Maesha Miller |
First Address | Salt Lake City, UT 84107-4257 |
Second Address | Park City, UT 84098-5684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/09/2012 |