Healthcare Provider Details

I. General information

NPI: 1811965817
Provider Name (Legal Business Name): ALAN KENNETH WARD MOTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S 200 W
BLANDING UT
84511-3910
US

IV. Provider business mailing address

PO BOX 745
BLANDING UT
84511-0745
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-3869
  • Fax: 435-678-3769
Mailing address:
  • Phone: 435-678-3869
  • Fax: 435-678-3769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5009456-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: