Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 369546-4201 | UT |
NPI | 1346843315 |
---|---|
Provider Name | Nathan Lee Pope |
First Address | Salem, UT 84653-2077 |
Second Address | Salem, UT 84653-2077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2020 |
Last Update Date | 20/11/2020 |