Individual
GEORGEANNA REYES OCTAVIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6910 S HIGHLAND DR, COTTONWOOD HEIGHTS, UT 84121-3060
(800) 434-8923
Mailing address
2800 N HILL FIELD RD, LAYTON, UT 84041-1375
(818) 648-5401
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/25/2020
Last updated
12/08/2020
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