MEDICARE: CAROL DAWN HUBER TRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	5264541-4003	UT

General Provider Information

NPI Number	:	1154170264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL DAWN HUBER TRT

Provider Business Mailing Address
First Line	:	510 S 500 W
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-4301
Country	:	US
Telephone Number	:	435-790-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 S 500 W
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-4301
Country	:	US
Telephone Number	:	435-781-3512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	05/13/2024

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Directions to “ CAROL DAWN HUBER TRT” Practice Location

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