Individual
KAITLYN JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 W 5400 S, TAYLORSVILLE, UT 84123-5310
(385) 646-4418
Mailing address
2500 S STATE ST, SOUTH SALT LAKE, UT 84115-3164
(385) 646-5000
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
10931349-4202
UT
Other
Enumeration date
05/18/2022
Last updated
05/18/2022
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