Individual
MRS. JACQLYN FITZGERALD OTTOSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4980
Mailing address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4980
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1208452401
UT
Other
Enumeration date
02/19/2010
Last updated
02/19/2010
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