Individual
PETER KENNEDY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
166 W 1325 N STE 100, CEDAR CITY, UT 84721-7793
(435) 586-0064
Mailing address
652 S MEDICAL CENTER DR, ST GEORGE, UT 84790-7049
(435) 251-3760
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
10533523-4201
UT
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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