MEDICARE: THERESA J WOODEN OTR/L

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	225X00000X	Occupational Therapist	378913-4201	UT

General Provider Information

NPI Number	:	1053330597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA J WOODEN OTR/L

Provider Business Mailing Address
First Line	:	2762 N 1375 E
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-3419
Country	:	US
Telephone Number	:	801-782-5935
Fax Number	:	801-782-5136

Provider Business Practice Location Address
First Line	:	2762 N 1375 E
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-3419
Country	:	US
Telephone Number	:	801-782-5935
Fax Number	:	801-782-5136

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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