Healthcare Provider Details

I. General information

NPI: 1497257257
Provider Name (Legal Business Name): WADE HUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N 400 E
NEPHI UT
84648-2202
US

IV. Provider business mailing address

206 N 2100 W
SALT LAKE CITY UT
84116-4740
US

V. Phone/Fax

Practice location:
  • Phone: 435-623-1721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9689795-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: