Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 9495248-4201 | UT |
NPI | 1679949432 |
---|---|
Provider Name | Whitney Louder |
First Address | Salt Lake City, UT 84117-7051 |
Second Address | Salt Lake City, UT 84117-7051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
465263499 | MEN (01) | UT |