Healthcare Provider Details

I. General information

NPI: 1447921515
Provider Name (Legal Business Name): ALINA KATHERINE DECAROLIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1150 S 400 E UNIT 4
SALT LAKE CITY UT
84111-4768
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7000
  • Fax:
Mailing address:
  • Phone: 802-399-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12347158-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: