Individual
GENESSA OAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
209 W 300 N, LOGAN, UT 84321-3809
(435) 716-8535
Mailing address
209 W 300 N, LOGAN, UT 84321-3809
(435) 716-8535
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
74151104201
UT
Other
Enumeration date
08/04/2009
Last updated
05/08/2014
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