Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1639714926 |
---|---|
Provider Name | Whitney Petri |
First Address | Ogden, UT 84403-3195 |
Second Address | Ogden, UT 84403-3195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2019 |
Last Update Date | 11/11/2019 |