Healthcare Provider Details

I. General information

NPI: 1780766733
Provider Name (Legal Business Name): MEGAN M WILLIAMS EVANS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 FASHION BLVD
MURRAY UT
84107-6121
US

IV. Provider business mailing address

PO BOX 27247
SALT LAKE CITY UT
84127-0247
US

V. Phone/Fax

Practice location:
  • Phone: 801-269-2696
  • Fax: 801-269-2690
Mailing address:
  • Phone: 801-269-2696
  • Fax: 801-269-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number323324-4201
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number323324-4201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: