Healthcare Provider Details

I. General information

NPI: 1831029529
Provider Name (Legal Business Name): MELANIE LYNN HEWITT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 E 1450 S
CLEARFIELD UT
84015-1610
US

IV. Provider business mailing address

89 W DIAMOND ST
LAYTON UT
84041-2552
US

V. Phone/Fax

Practice location:
  • Phone: 801-728-4300
  • Fax:
Mailing address:
  • Phone: 801-643-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14287983-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: