Healthcare Provider Details

I. General information

NPI: 1518712512
Provider Name (Legal Business Name): MARIAH BONET LEROUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12453 S 265 W STE B
DRAPER UT
84020-5420
US

IV. Provider business mailing address

12760 S PARK AVE UNIT 363
RIVERTON UT
84065-3415
US

V. Phone/Fax

Practice location:
  • Phone: 801-443-7775
  • Fax: 801-447-0107
Mailing address:
  • Phone: 801-443-7775
  • Fax: 801-447-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: