Healthcare Provider Details

I. General information

NPI: 1467318915
Provider Name (Legal Business Name): WILLIAM TUCKER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5284 S COMMERCE DR STE C214
MURRAY UT
84107-5568
US

IV. Provider business mailing address

522 E 3085 S
SOUTH SALT LAKE UT
84106-5202
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5492
  • Fax:
Mailing address:
  • Phone: 786-575-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14265609-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: