Healthcare Provider Details

I. General information

NPI: 1497040869
Provider Name (Legal Business Name): SUMMIT HAND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 W ANTELOPE DR SUITE 1-D
LAYTON UT
84041-4953
US

IV. Provider business mailing address

1992 W ANTELOPE DR SUITE 1-D
LAYTON UT
84041-4953
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-2633
  • Fax: 801-773-1533
Mailing address:
  • Phone: 801-773-2633
  • Fax: 801-773-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL J DELONG
Title or Position: OCCUPATIONAL THERAPIST/ OWNER
Credential: O.T.D.
Phone: 801-773-2633