Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 101241-4201 | UT |
NPI | 1174615090 |
---|---|
Provider Name | Marilyn Kay Lyman |
First Address | Ogden, UT 84405-4736 |
Second Address | Ogden, UT 84405-4736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 25/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870502207001 | (05) | UT |