Individual
MRS. STEPHANIE LEEANN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
1952 E 7000 S, SALT LAKE CITY, UT 84121-6877
(801) 495-5227
Mailing address
1952 E 7000 S, SALT LAKE CITY, UT 84121-6877
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
340168
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WALLSL115QC
DRIVER LICENSE NUMBER
WA
Enumeration date
03/16/2015
Last updated
03/18/2015
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