MEDICARE: OLIVIA NICOLE WOZAB

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	226000000X	Recreational Therapist Assistant	13969796-4003	UT

General Provider Information

NPI Number	:	1326930041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA NICOLE WOZAB

Provider Business Mailing Address
First Line	:	433 E 2700 S
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-3325
Country	:	US
Telephone Number	:	801-487-2248
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 E 2700 S
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-3325
Country	:	US
Telephone Number	:	801-487-2248
Fax Number	:	801-746-0764

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

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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Directions to “ OLIVIA NICOLE WOZAB ” Practice Location

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