Healthcare Provider Details

I. General information

NPI: 1588595474
Provider Name (Legal Business Name): CLARISSA MARIE HANSEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLARISSA MARIE WILLIAMS LMT

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14736 S SILVER BLOSSOM WAY
DRAPER UT
84020-1479
US

IV. Provider business mailing address

14736 S SILVER BLOSSOM WAY
DRAPER UT
84020-1479
US

V. Phone/Fax

Practice location:
  • Phone: 801-651-0916
  • Fax:
Mailing address:
  • Phone: 801-651-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5177541-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: