Individual
MARIE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TRT
Contact information
Practice address
4090 W PIONEER PKWY, WEST VALLEY CITY, UT 84120-2060
(801) 397-4400
Mailing address
2994 S 1100 E, SALT LAKE CITY, UT 84106-2672
(801) 910-6427
Taxonomy
Speciality
Code
Description
License number
State
226000000X
Recreational Therapist Assistant
Primary
10870840-4003
UT
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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