Healthcare Provider Details

I. General information

NPI: 1659236180
Provider Name (Legal Business Name): ALLISON MICHELLE ORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N 400 E
LOGAN UT
84341-7525
US

IV. Provider business mailing address

564 E 400 N APT 9
LOGAN UT
84321-6408
US

V. Phone/Fax

Practice location:
  • Phone: 435-750-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14257703-4003
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: