Individual
ELIZA MAVIS ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 N 500 W, PROVO, UT 84604-3305
(801) 377-9661
Mailing address
1460 E SHANE CIR, SANDY, UT 84092-5939
(801) 906-9196
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
14195558-4003
UT
Other
Enumeration date
12/13/2024
Last updated
12/13/2024
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