Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12544 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 9621933-4201 | UT |
NPI | 1679829675 |
---|---|
Provider Name | Mrs. Corinne Qudsiyih Sheahan |
First Address | Salt Lake City, UT 84113-1103 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 03/05/2016 |