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Individual

CONNOR WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
85 N MEDICAL DR, SALT LAKE CITY, UT 84112-1100
(801) 587-3422
Mailing address
445 N HALE ST, GRANTSVILLE, UT 84029-9398

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary

Other

Enumeration date
11/20/2023
Last updated
03/04/2024
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