Individual
LISHA MARIE MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12453 S 265 W STE B, DRAPER, UT 84020-5420
(801) 443-7775
(801) 447-0107
Mailing address
12760 S PARK AVE UNIT 363, RIVERTON, UT 84065-3415
(801) 443-7775
(801) 447-0107
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12667850-4201
UT
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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