Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003405192 |
---|---|
Provider Name | Olivia Dawn Fegter |
First Address | Provo, UT 84604-6428 |
Second Address | Orem, UT 84058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2021 |
Last Update Date | 19/01/2021 |