Individual
ELISE ROSE LICHTENBERG PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
10143483-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942854057
—
UT
Enumeration date
10/31/2016
Last updated
03/24/2020
Update your record
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