Individual
EMMA FERTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3845 W 4700 S, TAYLORSVILLE, UT 84129-3454
(801) 840-4379
Mailing address
3845 W 4700 S, TAYLORSVILLE, UT 84129-3454
(801) 840-4379
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
11797034-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568869899
—
UT
Enumeration date
08/02/2020
Last updated
06/25/2024
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