Individual
LACY PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1952 E 7000 S, SALT LAKE CITY, UT 84121-6877
(801) 942-3311
(801) 495-5303
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171-1185
(801) 942-3311
(801) 495-5303
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3646
AZ
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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