MEDICARE: AMY STURDIVANT

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	225800000X	Recreation Therapist	6677495-4003	UT

General Provider Information

NPI Number	:	1356213938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY STURDIVANT

Provider Business Mailing Address
First Line	:	5957 GENOA LN
Second Line	:
City	:	STANSBURY PARK
State	:	UT
Zip	:	84074-8950
Country	:	US
Telephone Number	:	801-696-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 E BRIGHTON POINT DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5513
Country	:	US
Telephone Number	:	801-831-8463
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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