MEDICARE: MR. TYLER SASE

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	52017004202	UT

General Provider Information

NPI Number	:	1134317019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TYLER SASE

Provider Business Mailing Address
First Line	:	269 E 1150 N
Second Line	:
City	:	HARRISVILLE
State	:	UT
Zip	:	84404-4082
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3893 N JACKSON AVE
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-6502
Country	:	US
Telephone Number	:	801-726-9742
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	08/22/2023

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