Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Occupational Therapist |
|---|
| Location | 12453 S 265 W Ste B, Draper, Utah |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1568869899
- Provider Enumeration Date: 12/02/2014
- Last Update Date: 05/21/2019
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568869899 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225700000X | Massage Therapist | 5044485-4701 (Utah) | Secondary |
| 225X00000X | Occupational Therapist | 5044485-4201 (Utah) | Secondary |
| 225X00000X | Occupational Therapist | 6717450-4201 (Utah) | Primary |
| 235Z00000X | Speech-language Pathologist | 9554558-4102 (Utah) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Po Box 363,
Riverton, UT 84065-0363
Ph: (801) 443-7775 |
12453 S 265 W Ste B,
Draper, UT 84020-5420
Ph: (800) 472-9515 |
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