Individual
MRS. SHONDEL GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7442 S 240 E, MIDVALE, UT 84047-2191
(801) 641-1735
Mailing address
7442 S 240 E, MIDVALE, UT 84047-2191
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5341395-4202
UT
Other
Enumeration date
05/10/2008
Last updated
05/10/2008
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