Healthcare Provider Details

I. General information

NPI: 1790328359
Provider Name (Legal Business Name): INTEGRATED AUTISM THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5984 S SUSQUEHANNA
MURRAY UT
84123-5527
US

IV. Provider business mailing address

PO BOX 127
NAPA CA
94559-0127
US

V. Phone/Fax

Practice location:
  • Phone: 801-243-5868
  • Fax:
Mailing address:
  • Phone: 707-255-3300
  • Fax: 707-255-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BARBIE NIEDERHAUSER
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 801-913-9963