Individual
CAMMY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
633 N 1420 W, CLINTON, UT 84015-9379
(801) 643-2685
Mailing address
633 N 1420 W, CLINTON, UT 84015-9379
(801) 643-2685
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
456136
UT
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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