Healthcare Provider Details

I. General information

NPI: 1912417163
Provider Name (Legal Business Name): MADELINE ROSE HALPERIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10160 E STATE HIGHWAY 210
ALTA UT
84092-9509
US

IV. Provider business mailing address

10160 E STATE HIGHWAY 210
ALTA UT
84092-9509
US

V. Phone/Fax

Practice location:
  • Phone: 801-989-4187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12396160-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: