Provider Demographics
NPI:1154170264
Name:HUBER, CAROL DAWN (TRT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:DAWN
Last Name:HUBER
Suffix:
Gender:F
Credentials:TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S 500 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4301
Mailing Address - Country:US
Mailing Address - Phone:435-790-3049
Mailing Address - Fax:
Practice Address - Street 1:510 S 500 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4301
Practice Address - Country:US
Practice Address - Phone:435-781-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5264541-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist