Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 8152257-4201 | UT |
NPI | 1023381522 |
---|---|
Provider Name | Todd Crae Williams |
First Address | Logan, UT 84341-2406 |
Second Address | Logan, UT 84341-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |