MEDICARE: MS. MICHELLE D WELLMAN OT

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	224Z00000X	Occupational Therapy Assistant	OC00001051	WA
2	225X00000X	Occupational Therapist	OT61194912	WA

General Provider Information

NPI Number	:	1043488570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE D WELLMAN OT

Provider Business Mailing Address
First Line	:	572 S CROOKED POST WAY
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-5449
Country	:	US
Telephone Number	:	509-851-3791
Fax Number	:	801-285-4301

Provider Business Practice Location Address
First Line	:	3741 W 12600 S STE 200
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7215
Country	:	US
Telephone Number	:	801-285-3400
Fax Number	:	801-285-3401

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

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	06/30/2022

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