MEDICARE: BOUNCE THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist
2	225XE1200X	Ergonomics Occupational Therapist
3	225XG0600X	Gerontology Occupational Therapist
4	225XL0004X	Low Vision Occupational Therapist
5	225XM0800X	Mental Health Occupational Therapist
6	225XN1300X	Neurorehabilitation Occupational Therapist
7	225XP0200X	Pediatric Occupational Therapist
8	225XE0001X	Environmental Modification Occupational Therapist
9	225XP0019X	Physical Rehabilitation Occupational Therapist

General Provider Information

NPI Number	:	1255021424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNCE THERAPY LLC

Provider Business Mailing Address
First Line	:	6318 VIEW DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6156
Country	:	US
Telephone Number	:	435-655-1210
Fax Number	:

Provider Business Practice Location Address
First Line	:	6318 VIEW DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6156
Country	:	US
Telephone Number	:	435-655-1210
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	ALICIA CLARK
Credential	:	OTR/L
Telephone Number	:	435-655-1210

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	06/27/2023

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Directions to “BOUNCE THERAPY LLC ” Practice Location

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