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General NPI Number Information
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NPI Number | 1003547746
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Entity Type | Individual
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Provider Name | RUTH JENSEN WALTON MOT
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Gender | Female
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 79 E CENTER ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6126
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Country | US
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Telephone | 801-230-9705
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Fax |
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Provider Business Mailing Address
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Address Line | 2679 OAKWOOD DR
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City | BOUNTIFUL
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State | UT
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Zip | 84010-3242
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Country | US
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Telephone | 801-230-9705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 9434553-4201
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License Number State | UT
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