Healthcare Provider Details

I. General information

NPI: 1154200525
Provider Name (Legal Business Name): STEPHANIE VASQUEZ QUITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E 300 N
AMERICAN FORK UT
84003-1717
US

IV. Provider business mailing address

1928 S 1030 W
OREM UT
84058-8145
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-5293
  • Fax:
Mailing address:
  • Phone: 914-648-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: