Healthcare Provider Details

I. General information

NPI: 1932859725
Provider Name (Legal Business Name): AMY CHIDESTER KENNEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 W 1550 N STE H
LAYTON UT
84041-2279
US

IV. Provider business mailing address

1491 W JACK CREEK LN UNIT 107
FARMINGTON UT
84025-3174
US

V. Phone/Fax

Practice location:
  • Phone: 801-618-7903
  • Fax:
Mailing address:
  • Phone: 801-200-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14220122-4201
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: