Healthcare Provider Details

I. General information

NPI: 1396751210
Provider Name (Legal Business Name): JAY P ANDERSEN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 500 E
LOGAN UT
84341-2408
US

IV. Provider business mailing address

PO BOX 25537
SALT LAKE CITY UT
84125-0537
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-2880
  • Fax:
Mailing address:
  • Phone: 435-716-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number53405374201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: