Individual
NICHOLAS KEITH SIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
150 E MAIN STREET, CASTLEDALE, UT 84513
(435) 381-5100
(435) 381-5099
Mailing address
PO BOX 307, BOUNTIFUL, UT 84011-0307
(801) 294-6907
(801) 294-6917
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7166585-4201
UT
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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