Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 7979743-4201 | UT |
NPI | 1003194937 |
---|---|
Provider Name | Tina L Williams |
First Address | Heber City, UT 84032-2247 |
Second Address | Heber City, UT 84032-2247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2011 |
Last Update Date | 31/10/2011 |