Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XH1200X | Occupational Therapist - Hand | 12328548-4201 | UT |
NPI | 1023588464 |
---|---|
Provider Name | Michelle Braithwaite |
First Address | Layton, UT 84041-4974 |
Second Address | Layton, UT 84041-4974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 02/08/2021 |